An Ohio hospital trains liberal arts college students as community health workers. After the first year, patients enrolled in the program had a 26% reduction of ED use and 51% reduction in hospital readmissions.
When I was working as an RN, I had a unit director who used to say, "There's three sides to every story—her side, his side, and what really happened, which is usually someplace in the middle."
She applied that concept to mediating employee squabbles, but the idea relates to patients, too. It could be said there are three sides to every admission (and readmission)—what's observed in the inpatient setting, what the patient says, and what's really going on in the patient's home.
AlexSandra Davis, RN, BSN
AlexSandra Davis, RN, BSN, recently experienced this when a patient was referred to Wooster (OH) Community Hospital's Community Care Network, a program that trains and uses college students as community health workers. Both the patient and her case manager said she was safe to go home, but when Davis, who is manager of the Community Care Network, got to the woman's residence she saw the third side of the story.
"I got in the home and she didn't have her medication, she didn't have her breathing treatments, she didn't have a nebulizer, she didn't have a glucometer to check her blood sugar," says Davis. "But when you asked her if she was OK to go home, she'd say, 'I'm fine to go home.'"
If left unchecked, those issues could have led to a hospital readmission. Wooster's Community Care Network, a partnership between the hospital and The College of Wooster, was launched in 2013 to prevent situations like this.
The Beginnings of an Idea
"I was interested in doing some things with transition of care and really looking at readmissions and patients bouncing back to either readmission or to the ED," says former Wooster CNO Loraine Frank-Lightfoot, RN, DNP. "We already had a good readmission rate, but this was something that could reach even more people and make more of a difference."
Frank-Lightfoot, now CNO at Parkview Regional Medical Center and Affiliates in Ft. Wayne, IN, knew that as manager of Wooster's home health and private duty divisions, Davis had done some preliminary work with the organization's cardiologists to prevent readmissions among heart failure patients. She had also heard about how Barry Bittman, MD, was using college students as community health workers in Meadville, Pa.
Jennifer Thew, RN, is the senior nursing editor at HealthLeaders.