The state of Wisconsin has more than 3,600 Assisted Livings Facilities (ALFs) which care for nearly 52,500 residents. University Hospital serves as the acute health care setting for more than 1,100 of these residents yearly. The majority of these residents are aged, frail and disabled with complex health care needs.
Recognizing the need to address communication surrounding transitions across the continuum of care and ALF staff education, in October 2014 UW Health's Director of Transitional Care Maria Brenny-Fitzpatrick, DNP, RN, FNP-C, GNP-BC, established the University Hospital Acute-Care Assisted Living Care Coalition.
Membership of the coalition is comprised of 20-30 ALFs most from the surrounding area but some as far away as 200 miles. Outputs of the meetings include such things as the development of a telephone hotline to be used by the ALFs to coordinated care with inpatient staff, provision of telephone numbers for the emergency department, respiratory therapy, nutrition and pharmacy departments; and multiple educational sessions surrounding clinical issues to improve the clinical care of the ALF residents. One of the many highlights of the coalition meetings is the sharing of best practices and evidence-based transition tools. The coalition is currently working with the Wisconsin Division of Quality Assurance to develop a Facility Capabilities Tool, which will alert hospital staff to the clinical capabilities of each facility.
The coalition meets as a group working on improving communication between sites, improving ALF staff early recognition of patient change in health condition and reducing avoidable readmissions by implementing several Interventions to Reduce Acute Care Transfers for Assisted Living (INTERACT) tools.
The coalition has been involved in several initiatives to date:
The mission of the UW Acute Care-Assisted Living (AL) Transitions Coalition is to improve the quality of care for AL residents who transition among health care settings. This will happen through a comprehensive coalition effort including improving cross-setting communication, care coordination, the use of standardized communication and assessment tools and the education of staff in both settings.
If you have questions or your agency would like to become a member of the coalition, please contact Kim Loun at email@example.com or (608) 828-8542.