Local Hospitals Work Together to Find Ways to Reduce Avoidable Readmissions

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Long Beach Care Transitions Collaborative

Long Beach Care Transitions Collaborative team members Lydia Ortega, St. Mary SNF/Lab Outreach Rep; Kit Katz, St. Mary Senior Center Coordinator; Laura Cargill, St. Mary Director of Case Management; Ardel Avelino, Director of Quality Management; Lindsay Holland, HSAG Clinical Project Manager; Tom Salerno, St. Mary President; and Markus Mettler, VP Operations, Healthcare Management Services, LLC.

On November 30, with guidance from the Health Services Advisory Group, a national health care quality improvement organization, St. Mary Medical Center hosted the first area quarterly Long Beach Care Transitions Collaborative to focus on cohesive strategies that will reduce hospital readmissions communitywide. Participants in attendance, who are part of the Collaborative, included Long Beach Memorial, Community Hospital, Miller Children’s Hospital, Los Alamitos Medical Center, Pacific Hospital, and Lakewood Regional Medical Center, as well as area skilled nursing facilities and representatives from the Long Beach Fire Department.

“Improving care transitions and reducing readmissions have become extremely important as we move into a new era of care coordination. It is no longer acceptable for hospitals and other healthcare providers to work in silos; they must form community partnerships to provide seamless coordinated care across the Continuum,” said Lindsay Holland, Clinical Project Manager for the Health Services Advisory Group. 

“Readmission has become a challenge nationally and we have decided to take on this challenge locally through this newly formed Long Beach Care Transitions Collaborative,” said Thomas Salerno, St. Mary Medical Center President & CEO. “I am excited to work with this group of medical colleagues, and I am confident that together we can create positive changes in health care.”

Speakers included Ardel Avelino, Director of Quality Management, St. Mary Medical Center and Tom Salerno, CEO, St. Mary Medical Center, who welcomed the group of 80 plus participants and went over key actions to prevent re-hospitalization; Lindsay Holland, Clinical Project Manager, Health Services Advisory Group, addressed how to improve care transitions; Markus Mettler, VP of Operations, Healthcare Management Services, LLC, provided a skilled nursing facility perspective; followed by a group discussion facilitated by Lydia Ortega, SNF/Laboratory Outreach Representative for St. Mary Medical Center and Laura Cargill, Director, Case Management for St. Mary Medical Center.

Studies show that creating more tailor-made easy-to-follow discharge plans that focus on meeting the needs of the patient, finding the right facility or caregiver for the patient upon discharge, and taking advantage of advances in technology that allow for more effective discharges, can help hospitals reduce their readmission rates. Talks are under way to schedule the next quarterly meeting.


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