Wood County Human ServicesWood County Human ServicesMental Health CollaborationMental Health CollaborationExecutive Sponsors: Executive Sponsors: Kathy Roetter, DirectorKathy Roetter, Director

Change Leader: Change Leader: Randall Ambrosius, Treatment Services ManagerRandall Ambrosius, Treatment Services Manager

Kristi Smith, Norwood Social Services ManagerKristi Smith, Norwood Social Services Manager

Change Member Team: Change Member Team:

Health Information Services Manager: Health Information Services Manager: Pam MartinsonPam Martinson

AIMSAIMS

The Big Aim:The Big Aim:

Reduce hospital readmission to Norwood Health Reduce hospital readmission to Norwood Health Care CenterCare Center

Little Aim:Little Aim:

Reduce cost to agencyReduce cost to agency

ChangeChange

Cycle 1:Cycle 1: Collect baseline data Collect baseline data

Cycle 2:Cycle 2: Complete crisis plan with client prior to Complete crisis plan with client prior to discharge from Norwood Health Care Center discharge from Norwood Health Care Center

Cycle 3:Cycle 3: Crisis planning focused on clients who have Crisis planning focused on clients who have had several hospital readmissionshad several hospital readmissions

Cycle 4:Cycle 4: Crisis planning focused on clients who have Crisis planning focused on clients who have been hospitalized several timesbeen hospitalized several times

RESULTSRESULTSBaseline 13% of individuals re-hospitalized prior to start of change Baseline 13% of individuals re-hospitalized prior to start of change

projectprojectAverage re-hospitalization for 5 month cycle is 10.8%Average re-hospitalization for 5 month cycle is 10.8%

Next StepNext Step

1.1. Begin utilizing new CBRF program known as Begin utilizing new CBRF program known as Bridgeway as of October 2014Bridgeway as of October 2014

2.2. Educate new staff on process to maintain Educate new staff on process to maintain sustainabilitysustainability

3.3. Look at way to improve crisis planningLook at way to improve crisis planning

1.1. Reduction on unnecessary paperworkReduction on unnecessary paperwork

2.2. Distribution of crisis planningDistribution of crisis planning

3.3. Utilize teaming processUtilize teaming process

ImpactImpact

A.A. Clients are stabilized in their own homeClients are stabilized in their own home Less traumaticLess traumatic

B.B. Staff time is utilized more efficientlyStaff time is utilized more efficiently

C.C. Reduction in cost to tax payersReduction in cost to tax payers