Aiming to improve the transition of patients from hospital to home, a team at one healthcare organization completed a performance improvement project leveraging the registered nurse to lead the transition of care phone call and visit in collaboration with the primary care physician…
This session discusses the development of a care coordination pilot program to address complex needs of pediatric gastroenterology patients, with the goals of preventing overuse of the emergency room and inpatient admissions while increasing compliance with plans of care…
In these short rapid-fire presentations, multiple speakers highlight approaches to managing issues related to social determinants of health in the practice environment…
This session discusses the development of a chronic disease care management program at our academic medical center to address the needs of complex moderate- to high-risk patients and reduce repeat emergency department utilization and hospital readmissions for these specified populations…
Patients transitioning from an inpatient hospital stay to self-care responsibilities post-discharge are at risk for readmission, resulting in increased cost and resource utilization. Care transition programs can result in cost avoidance and decreased resource utilization…
This presentation discusses the implementation strategy for centralizing nursing services to support primary care practices as well as the tools and tactics for tracking RN work and value-based program outcomes as a result of centralization…
Ambulatory care is a rapidly growing field of nursing practice. As this specialty practice grows, there have been efforts to identify the desired role of the registered nurse in ambulatory care and link it to patient outcomes…
Having a warfarin protocol in place is only half the battle. It is imperative that protocol be followed and documented with each encounter. This presentation discusses how to closely monitor labs and provide care for the non-compliant patient…
In these short rapid-fire presentations, multiple speakers highlight approaches to managing issues related to behavioral health in the practice environment…
In a value-based care environment, successful outcome measures include improved quality of care while limiting costs. This session discusses a transitional care program implemented to support post-discharge follow-up…
This session discusses the interventions leading to the successful implementation of RN-led visits for chronic disease management in the primary care setting…
CCTM is growing nationwide, and principles and evidence-based resources are constantly being created and updated to support ambulatory care nursing. During this session the CCTM SIG meets to discuss the latest evidence-based tools and research…
Transitional care management (TCM) refers to interventions promoting the safe and timely transfer of patients through various levels of care and across care settings. This session describes several interventions to improve transitional patient care management in the ambulatory care setting…
In these short rapid-fire presentations, multiple speakers highlight approaches to managing issues related to telehealth nursing in the practice environment…
This session explores the value-added role of enhanced primary care RNs in rural health clinics and the impact they have on quality, access, and revenue…
This session discusses how one health care practice developed a registered nurse to serve as a clinical liaison (RNCL) in the hospital to help enrollment in care management programs…
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