This is a set of slides I put together for a briefing for the Metro Maryland Ostomy Association. It is on the topic of patients being involved with their healthcare and focuses on improving safety and quality to the extent practicable by a patient. I am a member of the Board of MMOA, and had an ileostomy for 13 years, up until just a few months ago when I had "j-pouch" surgery. I worked for the Dept of VA's National Center for Patient Safety from 2000 to 2010, and have been with the AHRQ Center for Quality Improvement and Patient Safety 3 years as of this posting.
APIC "Futures Summit" Presentation April 2006Noel Eldridge
This was a presentation that I was invited to give at a "Summit" - Special Board meeting with invited guests - of the Association for Professionals in Infection Control. I remeember Rick Shannon also speaking and being impressed by his work, and CDC being there too. I was invited to talk about incentives for improving patient safety in VA, and I also added in slides about my frustration with the data on HAIs at that time.
Large-Scale Disclosure Panel Presentation from 2008 Annual Meeting of America...Noel Eldridge
I was invited to present on a panel on the disclosure of adverse events at this annual meeting of the American Society for Bioethics and Humanities in Cleveland, and covered the VA policy at that time. I had been involved in the implementation of the policy and the writing of the policy documents, but not the core thinking behind the policy which was developed by a committee convened by the VA Center for Ethics in Health Care a few years earlier. Disclosure of adverse events is an area where VA has been a leader, but it has been challenging, especially in gray areas such as when it is unknown whether any patients were actually harmed by a breach in appropriate practices. The current VA policy is on-line at: http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2800 . Also on-line is a 2008 transcript when I participated as a speaker in a national VA call organized by the VA National Center for Ethics in Health Care: http://www.ethics.va.gov/docs/net/NET_Topic_20080226_Disclosure_of_Adverse_Events.doc
2001 Presentation to the NCVHS on VA's National Center for Patient SafetyNoel Eldridge
I think this was the first NCPS presentation I gave to an outside group of experts. The topic was the program itself and how it worked, and what it was trying to accomplish and what it was accomplishing. I had been in the job for about a year at this point. The meeting minutes are on-line at: http://www.ncvhs.hhs.gov/011212mn.htm One of the other presenters was Jim Battles of AHRQ. Now he and I have offices next door to each other at AHRQ (where I've been since 2010).
Presentation on Patient Safety Measurement for visitors from Sweden in 2007Noel Eldridge
This presentation was put together on the special topic of measurement when a group from Sweden was visiting the Dept of Veterans Affairs National Center for Patient Safety to learn about patient safety improvement programs underway there. I remember some of the people listening resisting my main point that so far there was no good way to measure PS outcomes, but some good ways to measure important outcomes that are potential precursors to patient safety problems (like not getting X-rays verified in a timely way).
The focus of this module is to explore patient/family centered care and how it links to incident analysis and management to will help to make care safer. Guest speakers and patient representatives will highlight what the patient needs are at different points during the incident analysis and management process. During small group discussions, participants will tap in to their own experiences and apply the “Checklist for Effective Meetings with Patients/ Families”.
Estratégias sobre Segurança do Paciente: Cuidados de Saúde para todos, sempre...Proqualis
Aula de Itziar Larizgoitia Jauregui, Coordenadora de Pesquisa e Gestão do Conhecimento do Programa de Segurança do Paciente da Organização Mundial de Saúde (OMS), durante o II Seminário Internacional sobre Qualidade em Saúde e Segurança do Paciente - evento do Qualisus - nos dias 13 e 14 de Agosto de 2013, no Ministério da Saúde, em Brasília.
APIC "Futures Summit" Presentation April 2006Noel Eldridge
This was a presentation that I was invited to give at a "Summit" - Special Board meeting with invited guests - of the Association for Professionals in Infection Control. I remeember Rick Shannon also speaking and being impressed by his work, and CDC being there too. I was invited to talk about incentives for improving patient safety in VA, and I also added in slides about my frustration with the data on HAIs at that time.
Large-Scale Disclosure Panel Presentation from 2008 Annual Meeting of America...Noel Eldridge
I was invited to present on a panel on the disclosure of adverse events at this annual meeting of the American Society for Bioethics and Humanities in Cleveland, and covered the VA policy at that time. I had been involved in the implementation of the policy and the writing of the policy documents, but not the core thinking behind the policy which was developed by a committee convened by the VA Center for Ethics in Health Care a few years earlier. Disclosure of adverse events is an area where VA has been a leader, but it has been challenging, especially in gray areas such as when it is unknown whether any patients were actually harmed by a breach in appropriate practices. The current VA policy is on-line at: http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2800 . Also on-line is a 2008 transcript when I participated as a speaker in a national VA call organized by the VA National Center for Ethics in Health Care: http://www.ethics.va.gov/docs/net/NET_Topic_20080226_Disclosure_of_Adverse_Events.doc
2001 Presentation to the NCVHS on VA's National Center for Patient SafetyNoel Eldridge
I think this was the first NCPS presentation I gave to an outside group of experts. The topic was the program itself and how it worked, and what it was trying to accomplish and what it was accomplishing. I had been in the job for about a year at this point. The meeting minutes are on-line at: http://www.ncvhs.hhs.gov/011212mn.htm One of the other presenters was Jim Battles of AHRQ. Now he and I have offices next door to each other at AHRQ (where I've been since 2010).
Presentation on Patient Safety Measurement for visitors from Sweden in 2007Noel Eldridge
This presentation was put together on the special topic of measurement when a group from Sweden was visiting the Dept of Veterans Affairs National Center for Patient Safety to learn about patient safety improvement programs underway there. I remember some of the people listening resisting my main point that so far there was no good way to measure PS outcomes, but some good ways to measure important outcomes that are potential precursors to patient safety problems (like not getting X-rays verified in a timely way).
The focus of this module is to explore patient/family centered care and how it links to incident analysis and management to will help to make care safer. Guest speakers and patient representatives will highlight what the patient needs are at different points during the incident analysis and management process. During small group discussions, participants will tap in to their own experiences and apply the “Checklist for Effective Meetings with Patients/ Families”.
Estratégias sobre Segurança do Paciente: Cuidados de Saúde para todos, sempre...Proqualis
Aula de Itziar Larizgoitia Jauregui, Coordenadora de Pesquisa e Gestão do Conhecimento do Programa de Segurança do Paciente da Organização Mundial de Saúde (OMS), durante o II Seminário Internacional sobre Qualidade em Saúde e Segurança do Paciente - evento do Qualisus - nos dias 13 e 14 de Agosto de 2013, no Ministério da Saúde, em Brasília.
Medical Legal Aspects and Concerns of the Mid-Level PratcionerBernard Racey
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Buy Drug Pharmacy consumer health fact sheet on protecting yourself from health care mistakes involving your prescription medicines, staying in the hospital, or undergoing surgery. Visit http://www.buydrug.in
Stop the Line – Empowering Clinicians to Recognize and Act on Impending Adver...marcus evans Network
Sara Atwell, RN, MHA, Oakwood Healthcare System - Speaker at the marcus evans National Healthcare CNO Summit 2012, held in Hollywood, FL, April 26-27, 2012, delivered her presentation entitled Stop the Line – Empowering Clinicians to Recognize and Act on Impending Adverse Events
MedicReS Winter School 2017 Vienna - Ethics of Cancer Trials - Adil E. ShamooMedicReS
A Comprehensive Introduction to the Ethical Issues at stake in the conduct of Cancer Research
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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
NSQIP 9-2007 Noel Eldridge FINAL 92407 for 925.pptxNoel Eldridge
Patient Safety Presentation to 2007 Veterans Health Association NSQIP Meeting - includes information on wrong site surgery, retained surgical items, human factors, and other topics
Medical Legal Aspects and Concerns of the Mid-Level PratcionerBernard Racey
Brief look at the legal aspects and concerns facing mid-level practioners (Physician Assistants and Nurse Practioners) in the United States Heath Care Systems
Buy Drug Pharmacy consumer health fact sheet on protecting yourself from health care mistakes involving your prescription medicines, staying in the hospital, or undergoing surgery. Visit http://www.buydrug.in
Stop the Line – Empowering Clinicians to Recognize and Act on Impending Adver...marcus evans Network
Sara Atwell, RN, MHA, Oakwood Healthcare System - Speaker at the marcus evans National Healthcare CNO Summit 2012, held in Hollywood, FL, April 26-27, 2012, delivered her presentation entitled Stop the Line – Empowering Clinicians to Recognize and Act on Impending Adverse Events
MedicReS Winter School 2017 Vienna - Ethics of Cancer Trials - Adil E. ShamooMedicReS
A Comprehensive Introduction to the Ethical Issues at stake in the conduct of Cancer Research
Adil E. Shamoo, Ph.D.
University of Maryland School of Medicine
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
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April 2005 Medication Safety Presentation for IOM CommitteeNoel Eldridge
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Some formatting is a little off in the translation to the current version of PowerPoint, but I didn't want to start editing and be tempted to change anything.
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Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
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RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
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Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
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Improving the Safety of Your Healthcare
1. 11
Improving the Safety
of Your Healthcare
(being an educated patient, advocating for
yourself, safe and patient-centered care)
For Metro Maryland Ostomy Association
Noel E. Eldridge, MSNoel E. Eldridge, MS
noel.eldridge@ahrq.hhs.govnoel.eldridge@ahrq.hhs.gov
neldridge202@yahoo.comneldridge202@yahoo.com
301 427-1156301 427-1156
202 641-5959202 641-5959
2. 22
What is Patient SafetyWhat is Patient Safety
Improvement Trying to Achieve?Improvement Trying to Achieve?
Our goal is to prevent harm to patients asOur goal is to prevent harm to patients as
they receive medical care. For example…they receive medical care. For example…
Adverse Drug Events (overdose, wrong drug,Adverse Drug Events (overdose, wrong drug,
drug interaction, etc.)drug interaction, etc.)
Wrong or Mixed-up Procedure, Test, or X-rayWrong or Mixed-up Procedure, Test, or X-ray
Patient Falls and Wandering PatientsPatient Falls and Wandering Patients
Healthcare-acquired InfectionsHealthcare-acquired Infections
Problems with Medical Devices –Problems with Medical Devices –
Malfunctions or Accidental MisuseMalfunctions or Accidental Misuse
3. 33
Books for Patients amazon.comBooks for Patients amazon.com
Take This Book to the Hospital With You:Take This Book to the Hospital With You:
A Consumer Guide to Surviving Your Hospital StayA Consumer Guide to Surviving Your Hospital Stay
(4.5 stars)(4.5 stars)
by Charles B. Inlanderby Charles B. Inlander
Buy this book withBuy this book with
How to Get Out of the Hospital AliveHow to Get Out of the Hospital Alive
(4.5 stars)(4.5 stars)
by Sheldon P. Blau, Elaine Fantle Shimbergby Sheldon P. Blau, Elaine Fantle Shimberg
4. 44
II’m not a doctor or a nurse’m not a doctor or a nurse
Information here is based:Information here is based:
On personal experiencesOn personal experiences
Reading and learning about adverseReading and learning about adverse
events in healthcare on my jobs overevents in healthcare on my jobs over
the last 12 yearsthe last 12 years
Listening to lots of doctors and nursesListening to lots of doctors and nurses
5. 55
Participating in Other SettingsParticipating in Other Settings
What do bus passengers have to do?What do bus passengers have to do?
Get on the correct bus & pay the fareGet on the correct bus & pay the fare
Follow basic bus rules – stay behind whiteFollow basic bus rules – stay behind white
line, donline, don’t talk to driver while bus is in motion,’t talk to driver while bus is in motion,
don’t do anything crazy like leaning out of andon’t do anything crazy like leaning out of an
open windowopen window
Keep track of where you are -- look out of theKeep track of where you are -- look out of the
window so you can ring bell at correct place towindow so you can ring bell at correct place to
get offget off
Not like the extremes of being an airplaneNot like the extremes of being an airplane
passenger or driving your own carpassenger or driving your own car
6. 66
Patients Participating inPatients Participating in
Patient SafetyPatient Safety
Hospital inpatients shouldnHospital inpatients shouldn’t have to do a’t have to do a
lot. Primary responsibility for inpatients islot. Primary responsibility for inpatients is
with hospital and healthcare providers.with hospital and healthcare providers.
Why?Why?
People are sick in the hospital – even sickerPeople are sick in the hospital – even sicker
than they used to be.than they used to be.
Many sick people arenMany sick people aren’t at their best mentally’t at their best mentally
(I know this firsthand).(I know this firsthand).
Sick people receiving healthcare shouldnSick people receiving healthcare shouldn’t’t
have to be vigilant about it. (my opinion)have to be vigilant about it. (my opinion)
7. 77
What Patients Can Do (1)What Patients Can Do (1)
Before Surgery: Participate in informedBefore Surgery: Participate in informed
consent that is really informed and reallyconsent that is really informed and really
consent.consent. (Think mortgage, not rental-car(Think mortgage, not rental-car
agreement.)agreement.)
Ask your surgeon:Ask your surgeon:
• Exactly what will you be doing?Exactly what will you be doing?
• About how long will it take?About how long will it take?
• What will happen after the surgery?What will happen after the surgery?
• How can I expect to feel during recovery?How can I expect to feel during recovery?
• Tell the surgeon, anesthesiologist, and nursesTell the surgeon, anesthesiologist, and nurses
about any allergies, bad reaction to anesthesia,about any allergies, bad reaction to anesthesia,
and any medications you are taking.and any medications you are taking.
8. 88
What Patients Can Do (2)What Patients Can Do (2)
Ask questions until you understand toAsk questions until you understand to
the extent that you care to understand.the extent that you care to understand.
Try hard not be accusatory as you askTry hard not be accusatory as you ask
questions, doctors and nurses intend toquestions, doctors and nurses intend to
help…and most of the time thathelp…and most of the time that’s what’s what
will happen (or at least no harm).will happen (or at least no harm).
Pay attention to the extent possible.Pay attention to the extent possible.
Willingly participate in safer systems –Willingly participate in safer systems –
e.g., done.g., don’t complain about being asked’t complain about being asked
your name 3 times by 3 different people.your name 3 times by 3 different people.
9. 99
What Patients Can Do (3)What Patients Can Do (3)
Before an Office Visit: Make a writtenBefore an Office Visit: Make a written
list of symptoms, questions, etc., tolist of symptoms, questions, etc., to
review during visit or interaction withreview during visit or interaction with
clinician.clinician.
Tell the doctor the truth about yourTell the doctor the truth about your
symptoms and history.symptoms and history.
Take your medicine or tell the doctor ifTake your medicine or tell the doctor if
you stop.you stop.
10. 1010
What Patients Can Do (4)What Patients Can Do (4)
Ask your doctor to provide you with a list ofAsk your doctor to provide you with a list of
the medications he/she has prescribed for youthe medications he/she has prescribed for you
– and keep it up to date. Add on any non-– and keep it up to date. Add on any non-
prescription drugs that you take regularlyprescription drugs that you take regularly
When thereWhen there’s a “better” choice – actually’s a “better” choice – actually
choose the better specialist, hospital, healthchoose the better specialist, hospital, health
plan, etc. But, one problem is defining betterplan, etc. But, one problem is defining better
– more timely, nicer, smarter, more up-to-– more timely, nicer, smarter, more up-to-
date, safety-conscious, good listener, gooddate, safety-conscious, good listener, good
referrer, gentler, etc.referrer, gentler, etc.
11. 1111
Other Steps to Safer Health CareOther Steps to Safer Health Care
fromfrom www.ahrq.gov/consumer/5steps.htmwww.ahrq.gov/consumer/5steps.htm
Get the results of any test orGet the results of any test or
procedure.procedure. Ask when and how you willAsk when and how you will
get the results of tests or procedures.get the results of tests or procedures.
Don't assume the results are fine if you doDon't assume the results are fine if you do
not get them. Call your doctor and ask fornot get them. Call your doctor and ask for
your results. Ask what the results mean foryour results. Ask what the results mean for
your care.your care.
Make sure you understand what willMake sure you understand what will
happen if you need surgery.happen if you need surgery. Ask yourAsk your
doctor, "Who will manage my care when Idoctor, "Who will manage my care when I
am in the hospital?"am in the hospital?"
12. 1212
Special Ostomy TopicsSpecial Ostomy Topics
Hydration (drink more water)Hydration (drink more water)
Potential for Blockages (carefully consider whatPotential for Blockages (carefully consider what
you eat – based on physician advice and youryou eat – based on physician advice and your
own experience -- and remember to chew)own experience -- and remember to chew)
Skin Care is Very ImportantSkin Care is Very Important
Potential for Hernias or AbscessesPotential for Hernias or Abscesses
Get Follow-ups as Recommended by yourGet Follow-ups as Recommended by your
Physician(s) or NursesPhysician(s) or Nurses
Ask if a Hospital has WOC Nurse(s)Ask if a Hospital has WOC Nurse(s)
13. 1313
Other Patient Safety TipsOther Patient Safety Tips
Agency for Healthcare Research andAgency for Healthcare Research and
QualityQuality
http://www.ahrq.gov/consumer/20tips.htmhttp://www.ahrq.gov/consumer/20tips.htm
http://www.ahrq.gov/consumer/5steps.pdfhttp://www.ahrq.gov/consumer/5steps.pdf
New: Guide to Patient and FamilyNew: Guide to Patient and Family
Engagement in Hospital Quality andEngagement in Hospital Quality and
SafetySafety
http://www.ahrq.gov/professionals/systems/hospitahttp://www.ahrq.gov/professionals/systems/hospita
14. The GuideThe Guide’s sections include—’s sections include—
Information to Help Hospitals Get Started Addresses:Information to Help Hospitals Get Started Addresses:
Strategy 1: Working With Patients and Families asStrategy 1: Working With Patients and Families as
AdvisorsAdvisors
Strategy 2: Communicating to Improve QualityStrategy 2: Communicating to Improve Quality
helps improve communication among patients, family members,helps improve communication among patients, family members,
clinicians, and hospital staff from the point of admission.clinicians, and hospital staff from the point of admission.
Strategy 3: Nurse Bedside Shift ReportStrategy 3: Nurse Bedside Shift Report
supports the safe handoff of care between nurses by involvingsupports the safe handoff of care between nurses by involving
the patient and family in the change of shift report for nurses.the patient and family in the change of shift report for nurses.
Strategy 4: IDEAL Discharge PlanningStrategy 4: IDEAL Discharge Planning
helps reduce preventable readmissions by engaging patientshelps reduce preventable readmissions by engaging patients
and family members in the transition from hospital to home.and family members in the transition from hospital to home.
1414