Resources
Super-Utilizer Coaching Package: What’s in Your Toolkit?
Use this package as a framework to develop super-utilizer reduction strategies and best practices and to support new AHS QA team members by highlighting what’s in the super-utilizer toolkit.
Readmission Driver Diagram – Reaching Your Goals
The Readmission Driver Diagram provides structure and guidance for teams implementing quality initiatives to reduce avoidable hospitalizations and emergency room visits. It represents theories of “cause and effect” in the system, what changes will likely cause the desired effects, sets the stage for defining the “how” elements of a readmissions project and provides links to […]
SBAR for Resident Change in Condition
Improve transitions of Care
Skilled Nursing Facility (SNF) Rehospitalization Risk Assessment Tool
Use this tool as a framework for interdisciplinary review, discussion, and individualized care planning for all skilled nursing facility admissions. It also has tips for incorporating the assessment tool into your facility’s readmission reduction strategy.