Waukesha County DHHS Clinical Services Division

1. The Diminishing Returns Project Waukesha County DHHS Clinical Services Division

2. Project Aims • Reduce the number of patients readmitted within 30 days of hospital discharge. 2009 readmission rate was 9.45% • Increase the percentage of first outpatient appointments kept. 2009 rates: ₀75% of therapist appointments ₀70% of psychiatrist appointments

3. Changes Streamlined discharge teaching: • Patients receive a one sheet summary of discharge information. Formalized day of discharge “check outs”: • Patients meet with their social worker and nurse to review appointments, crisis plan, community resources and medications. Follow-up phone calls within 3 days of discharge by crisis worker: • Review discharge information • Identify and eliminate barriers to successful transition to outpatient services • Provide crisis intervention if needed

4. Results30 Day Readmissions test baseline return to baseline

5. Results First Outpatient Appointment Kept

6. Next Steps/Impact Sustain process improvement. • Adopt discharge instruction sheet and “check outs”. The changes simplify and organize discharge instructions and reinforce the importance of post-hospital care. Shift focus from global process improvement to an individual case-based review. • Case-by-case review of reasons for readmission with patients readmitted within 30 days of discharge.