Congratulations go out to MetroWest Medical Center which, in collaboration with MetroWest HomeCare & Hospice, has been awarded the 2010 Betsy Lehman Patient Safety Recognition Award. The award honors leadership and innovation in patient safety and the development of systems-based solutions through the implementation of best practices. The theme for this year’s award focused on the importance of transitions in care across the healthcare continuum. Jane Pike–Benton, Executive Director at MetroWest HomeCare & Hospice, presented their innovative approach at the most recent statewide STAAR Learning Session and sent this along to the Home Care Alliance:
“ At Metro-West, we implemented a multi-faceted approach to the transitioning of patients that was designed and implemented via a strong cross-continuum collaboration between the home health agency and the hospital. The model includes:
- the implementation of a ‘teach back tool’ for patients with heart failure both within the hospital and through their transition to home with home care services
- the development of a standardized Heart Failure Protocol with front loading of home care visits, the use of a standardized teaching tool based upon evidenced-based research, an increase focus on medications, and the integration of phone calls by the home care case managers on non visit days
- post hospital telephonic support via the use of a calling center in conjunction with the MetroWest HomeCare Nurse Specialist intervening for these patients when gaps in care are identified
- the implementation of a Transition Care Coach who is also a MetroWest HomeCare Nurse who meets with the patients bedside prior to discharge from the hospital
- the implementation of a Palliative Care Team with members from both MetroWest Hospice and MetroWest Medical Center
These initiatives demonstrate the importance of cross-continuum collaboration to our patients and to our health care system. Our entire team is committed to implementing new and innovative ways to provide care for our highest risk patients, and to demonstrate the value that home health care offers to hospitals and other health care partners.”
Among those sending congratulations to MetroWest HomeCare & Hospice and MetroWest Medical Center on their innovative approach to patient care across the continuum was HHS Secretary Judy Ann Bigby, MD. Her comments as to MetroWest as a “shining example” were posted on the Commonwealth Conversations Public Health Blog.
Thank you to Jane and her team for demonstrating leadership in this crucial area of care transitions and readmission reduction.
Think Home Care Blog 
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