An innovative approach to transitioning care

An innovative approach to transitioning care

UT Southwestern Medical Center’s Susan Neill-Fogus shares how her team educates patients for post-discharge at TMF

“Our care coordinators were getting a ton of calls after hours, for things the patient should have learned while they were in the hospital—details about medications and labs. So we began to think maybe we need to change the way we’re teaching our patients in-house.”
Susan Neill-Fogus, RN, MSN, Manager of Quality and Compliance for Solid Organ Transplant, UT Southwestern Medical Center

When the staff at UT Southwestern Medical Center in Dallas realized abdominal transplant patients were often overwhelmed by the binder of new information they received ahead of their discharge, they decided to help patients take ownership of the process during their entire stay.

“It starts the minute they get into the unit—the very first day the patient is there,” says Susan Neill-Fogus, who serves as Manager of Quality and Compliance for Solid Organ Transplant. “Everything that you will be doing at home by yourself we want you to do here in the hospital first before you leave.”

In the spirit of “see one, do one, teach one,” nurses perform the first dressing change, but the next time they bring supplies to the patient and allow them to do it themselves (watching to make sure they are doing it correctly).

Likewise for managing medications, taking vital signs and other self-care practices patients would need to perform themselves. Coached by nurses, the goal is for the patient to be as independent as possible to mimic being at home. Neill-Fogus says the patients love it and feel very engaged in the process.

“We had fantastic outcomes—our length of stay dropped, our ER visit rate dropped. And the phone calls dropped by over half. It was tremendous.”

About Susan Neill-Fogus

Neill-Fogus has worked with transplant patients her entire career, beginning as a staff nurse at Methodist Dallas Medical Center, where she went on to become first the inpatient transplant coordinator and then Senior Transplant Coordinator. She came to UT Southwestern Medical Center in 2011 and has served as Manager of Quality and Compliance for Solid Organ Transplant since 2017. She is also an experienced site surveyor, having conducted surveys under a contract for CMS from 2014-1018. Neill-Fogus is an active member of the Organization for Transplant Professionals, Texas Transplant Society and the International Transplant Nurses Society.

“Freedom Day: An Innovative Approach to Transitioning Care in Abdominal Transplant Patients” will be presented as part of the 27th Annual UNOS Transplant Management Forum. Connect with Susan Neill-Fogus and other transplant quality leaders at TMF in Orlando, May 14-16, 2019

Review TMF agenda

Do NOT follow this link or you will be banned from the site!
Share This