Valley Regional Hospital READMISSION QUERY When a patient is readmitted, conduct the following investigation. Today’s date: ______

Patient name: ______Date of 1st admission: ______Date of this admission: ______□ through ED □ Direct

I. Interview the patient and or family How do you think you became sick enough to come back to the hospital? ______

Have you seen your doctor in the office since you left the hospital? □ Yes Date: ______□ No I had an appointment scheduled for: ______

Have you seen any other specialist since you were here? □ Yes Date: ______Who? ______□ No

Did you have difficulty reaching your doctor or getting an office visit? □ Yes □ No ______Have you had trouble purchasing medications or even taking them? □ Yes □ No ______

Have you had trouble with getting your meals at home? □ Yes □ No ______

Did you feel ready for discharge when you left the last time? □ Yes □ No ______

Did you receive the services you thought were set up on discharge? □ Yes □ No What were those services? ______

Did you call your physician before you came to the ED? □ Yes □ No Did you physician tell you to come in? □ Yes □ No

If the patient had VNA ordered Did you call the VNA before you came? □ Yes □ No ______Did the VNA tell you to come to the hospital? □ Yes □ No ______Do you know if the VNA called your physician? □ Yes □ No ______

II. If the patient has home care services, Call them to discuss the patient’s admission.

III. If the patient came from an extended facility, Call them to discuss the patient’s admission.

IV. Ask the Care Team Members: What do you think caused the patient to be readmitted? ______

4/2012 ______

4/2012