Through our Congestive Heart Failure Navigator program, patients benefit from integrated, seamless care. Navigators arrange for a nurse to help you understand discharge instructions and medications, so you will feel comfortable upon your return home.
This follow-up, two to three days after discharge, is provided by a nurse from TriHealth. The nurse asks a series of questions to ensure that you understand the necessary steps for staying healthy.
A second call is made at 18 to 20 days, just before readmission rates typically increase. The program provides a Navigator for social workers, if necessary, to address psychosocial, financial and family issues. Throughout the process, the Navigator nurse maintains contact with your primary care physician as needed. Data indicates that this program is a promising start to improving CHF readmission rates.