Aurora West Allis Medical Center - Transition in Care

Transition in Care is a community paramedic program implemented by Aurora West Allis Medical Center and the West Allis Fire Department to help reduce hospital readmissions. Specially trained nurses refer recently discharged seniors to paramedics, who conduct a home visit to ensure that patients understand their medications and instructions from physicians. They also assess the patientâ€™s health and living environment. Findings are then reported to the nurses for follow-up, if needed.

What is it?

Transition in Care is a community paramedic program implemented by Aurora West Allis Medical Center and the West Allis Fire Department to help reduce hospital readmissions. Specially trained nurses refer recently discharged seniors to paramedics, who conduct a home visit to ensure that patients understand their medications and instructions from physicians. They also assess the patient’s health and living environment. Findings are then reported to the nurses for follow-up, if needed.

Who is it for?

High-risk seniors recently discharged from Aurora West Allis Medical Center.

Why do they do it?

Many older patients struggle when they return home after a multi-day stay at the hospital. This program offers hands-on coaching and support from local first responders who can answer questions and welcome patients home.

Impact

After 124 home visits with 29 patients, the fire department saw an 86 percent decrease in non-vital 911 calls and a 71 percent decrease in visits to the emergency department.

Contact: Rick Kellar
President
Telephone: 414-328-6000
Email: rick.kellar@aurora.org

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