This novel program at St. Vincent Indianapolis is helping high-risk patients with complex chronic disease by preventing these conditions from escalating after discharge from the hospital. Post-Acute Care can also prevent unnecessary re-admission to the hospital. We utilize a combination of intensive hospital follow-up by critical care trained medical associates in the Healthy Transitions Clinic, technologically advanced remote care monitoring, and access to Medical Alert devices and automated medication dispensers. The patients who participate in our Post-Acute Care Clinic and programs express greater confidence in their self-management skills, commenting:
8224 Naab Rd., Building 1, Suite 1H
Indianapolis, Indiana 46260
St. Vincent Medical Group has an intensive outpatient clinic that focuses on patients with complex chronic illnesses who have been hospitalized at St. Vincent Indianapolis. Our goal is to help these high-risk patients avoid hospital re-admission and address physical and psychosocial needs.
The Healthy Transitions Clinic is led by Mason Goodman, MD, a board-certified critical care pulmonologist, and critical care trained nurse practitioners Staci Agee, NP, and Melissa Merrill, NP.
Diseases like congestive heart failure, COPD, pneumonia and acute myocardial infarction account for a significant number of hospital re-admissions each year. Prior to the hospital discharge, a patient can be referred by the hospitalist, specialty provider or inpatient case manager to the Healthy Transitions Clinic based on:
At St. Vincent Indianapolis, a hospitalized patient with a complex chronic illness receives a pre-discharge assessment by a Healthy Transitions Clinic clinician. If eligible, the Healthy Transitions Clinic will provide ongoing care for up to 30 days post-discharge depending on the patient’s individual needs.
The first follow-up visit in the clinic is within 24-48 hours post-discharge. At this appointment our staff will identify barriers to health and develop:
We also help coordinate access to many types of services including:
This type of intensive (30-day) follow-up is helping patients make a stronger transition to better health, and to avoid hospital readmission. Our staff maintains an open communications network with all of the medical providers so that long-term treatment goals are communicated and progress in the Healthy Transitions Clinic is shared.
At St. Vincent we offer patients and caregivers throughout Indiana several options in Personal Emergency Response Systems (PERS) – also called Medical Alert devices. These devices help keep our loved ones safe and connected while alone at home or when doing independent activities.
Our featured devices are powered and monitored by Tunstall, a connected health company since 1957. These devices are connected to a 24/7 Medical Alert Response Center and use either landline phone technology, cable or cellular network connectivity. Ask about the automatic fall detection alert feature and GPS/location-based service technology.
At the installation, a St. Vincent associate completes the installation of all Medical Alert systems in the home and provides training on the equipment. The St. Vincent Medical Alert office provides local equipment and service support for our patients, caregivers and loved ones.
For more information about device details, see product descriptions below.
These Personal Emergency Response Systems are used by individuals of all ages that may require emergency attention or caregiver support:
Overall features and benefits include:
Health risks associated with medication mistakes and misuse can be avoided by using the automated Phillips medication dispenser. This equipment is connected to a landline telephone service. Alert notifications are immediately sent to the Medical Alert Call Center if a medication dose is missed, or if there is an equipment malfunction.
This medication dispenser can be programmed for up to 30 days of medication dosing depending on the medication type and the regimen prescribed by your physician. Daily, six medication doses can be dispensed in a 24-hour period.
Your St.Vincent Medical Alert associate will coordinate and install the medication dispenser, as well as, do the training and education for the patient and caregivers. This medication dispenser is programmable and displays messages and reminders with or without medication doses, for example: