JUNE 28 - JULY 2, 2020  
30 years of Care Transitions Across the Full Continuum

4001 – The “Right People in the Room” Approach to Complex Patients in a Large System

4001 – The “Right People in the Room” Approach to Complex Patients in a Large System

The highest complexity patients often face barriers in addition to medical care. They often get “stuck.” This session will review how the Cleveland Clinic Health System created a multidisciplinary escalation team to review patients whose transition planning was stuck, and how this team approach not only generated success for these patients, but also created best practices for future issues. The session will focus on the necessity of having the right people in the room, meaning a team comprised of people able to identify options for moving the patient forward,
and engage stakeholders in the plan of care. Further, the team must include members with the autonomy to select a course to move forward, as well as the discretion to execute decisions along the way. In addition to identifying team members, this session will include both demonstrations and role plays for participants.
Objectives:
1. Describe the utility of multi-disciplinary escalation teams in planning and evaluating patient post acute care transitions
2. Identify the members of a multi-disciplinary escalation team and their roles
3. Summarize the efforts and recommendations of multi-disciplinary escalation teams