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Atlantic General Hospital Garners Circle of Honor Award From Maryland Patient Safety Center

​Berlin, Md.Over the past decade, healthcare providers and organizations throughout the mid-Atlantic region have submitted their quality improvement programs to the Maryland Patient Safety Center for their Patient Safety Innovation Awards. For the third year in a row, Atlantic General Hospital has been recognized as one of the top ten, from nearly 80 submissions.

This year, Atlantic General was recognized for pioneering programs that have improved patient outcomes, thereby drastically reducing preventable hospital readmissions.

Atlantic General Hospital is currently ranked No. 4 in the state of Maryland for readmission prevention, with a rate of 9.93 percent (the state average is 12.85 percent). A readmission is usually defined as a patient’s being hospitalized again within 30 days of an initial hospital stay.

“The profound success of our accomplishments can only be attributed to the commitment and collaboration of our associates and medical staff within the hospital and community settings,” said Charles Gizara, RN, director of clinical integration at Atlantic General Hospital.

Efforts began in 2014 with the establishment of the Potentially Avoidable Utilization (PAU) team, which focuses on integrated care coordination to prevent avoidable hospital readmissions while improving patient outcomes across the continuum of care.

The PAU team meets each month to review Atlantic General’s performance compared to state of Maryland outcomes data and evaluate opportunities to improve community health through collaboration with health care professionals outside the traditional hospital setting.

Members include internal AGH clinical staff and physicians as well as community members from the Worcester County Health Department and local home health agencies and skilled nursing facilities.

Examples of innovative programs that have contributed to successful readmission reduction at Atlantic General Hospital:

Condition R – The early identification of a potential readmission. This program provides immediate intervention by a registered nurse case manager for any patient in the Emergency Room who has had a previous admission within the last 30 days.

The case manager meets with the patient and family to develop a personalized plan of care to treat underlying chronic conditions that may have led to the ER visit and get them on the path to better health.

Telehealth Collaboration with Berlin Nursing and Rehabilitation Center. A telemedicine program allows physician consultations to be performed for patients who have transferred from Atlantic General Hospital to Berlin Nursing and Rehabilitation Center if there is a change in their medical condition.

An AGH provider will perform an exam by video with assistance from the facility’s clinical staff in the privacy of the patient’s room and recommend interventions to prevent readmission when possible.

Since the program’s implementation, readmissions of patients previously discharged to the rehabilitation center have been reduced by 70 percent.

AGHRx RediScripts Pharmacy Concierge Program. The RediScripts Concierge Program helps close the medication safety loop by working closely with a patient’s care team to review and fill all of a patient’s discharge prescriptions. A concierge technician will deliver the medication directly to the bedside and call upon a pharmacist to provide personalized education on the medications. For the most critical patients, a pharmacist will place a follow up phone call to the patient within 72 hours of discharge to ensure that patients are taking their medication as prescribed and have all of their questions answered. More than 80 percent of inpatients opt in to take advantage of the AGHRx RediScripts Concierge Program.

Transitions in Care Program. – A dedicated registered nurse care coordinator works with patients during their transition from inpatient to community setting (home, rehabilitation center, etc.). The care coordinator works with the patient, primary care provider and community liaisons for a period of 31 days and serves as the patient advocate.

If services are required beyond this time, the patient may be referred to Atlantic General’s Patient Centered Medical Home. Less than eight percent of Transition in Care patients are readmitted to the hospital setting.

Caption: Atlantic General Hospital receives the Circle of Honor Patient Safety Innovation Award during the 2016 Maryland Patient Safety Conference. From left: Bob Yocubik, RN, director of quality at Atlantic General Hospital; Charles Gizara, RN, director of clinical integration at Atlantic General Hospital; Joan Lunden, 2016 Maryland Patient Safety Conference keynote speaker; Jeff Kukel, Pharm D., manager of AGHRx RediScripts Pharmacy; Robert H. Imhoff, III, president and CEO of the Maryland Patient Safety Center; and Michael Franklin, president and CEO of Atlantic General Hospital and Health System.

About Atlantic General Hospital

Atlantic General Hospital has been providing quality health care to the residents of Worcester, Wicomico, Somerset (Md.) and Sussex (Del.) counties since May 1993. Built by the commitment and generosity of a dedicated community, the hospital’s state-of-the-art facility in Berlin, Md., combines old-fashioned personal attention with the latest in technology and services. It provides quality specialty care such as weight loss surgery, orthopedics, outpatient infusion for individuals with cancer or blood/autoimmune disorders, retina surgery and a comprehensive women’s diagnostic center. Atlantic General Health System, its network of more than 40 primary care providers and specialists, care for residents and visitors throughout the region. For more information about Atlantic General Hospital, visit