PP205 – Plan of Care Rounds: Ensuing effective interdisciplinary communication with patient
Providing effective communication with collaborative care team and patients with daily plan of care rounds. Each member of the care team along with the patient discuss the plan of care and the best, safest transitional care plan. Follow and recommendations are discussed with patient. After plan of care rounds, case management and SW follows up with community case managers and physicians hand-off if need. Performing daily plan of care visits has increased patient outcomes, improved communication with staff and patient and also has increased our HCAP scores.