Carol is the case manager of the Clinical Decision Unit. A few years ago, a heart failure initiative to improve care to our heart failure patients was started. Carol's role was to assist by evaluating CDU HF patients for home care eligibility and referral. Carol has gone above and beyond in this role to ensure our patients have an adequate follow-up after discharge. She emails specific follow-up information including pertinent clinical information, persons contacted, patient needs and potential challenges after discharge to members of the Health Connect team on every HF patient regardless of whether they are eligible for home care. I believe that Carol was instrumental in decreasing our HF <30-day admission rate after CDU discharge from over 25% in 2011 to 12% in 2012 and is a key driving force to us consistently keeping it to where it is today, between 10% and 15%.
I believe the above example is a product of the passion she has for what she does and the 110% she consistently gives. She has gone out of her scope as case manager to ensure good transition of care from the hospital to the home, nursing home, etc by taking the extra time to speak and connect with all involved in this transition: patients, families, the CDU care team, consultants, primary care physicians, physician offices, etc to ensure a smooth transition of care. Carol is an active voice and advocates for our most vulnerable patients and proactively looks for ways to assist. She goes out of her way to identify any needs such as transportation and other barriers to follow-up. She works collaboratively with Health Connect so that high-risk patients are contacted after discharge. I have personally seen her assist patients in correctly identifying and contacting their primary care physicians and make follow-up appointments including at low-cost clinics. She also consistently looks to ensure the patient's primary care physician is correct on the banner bar.
Besides her endless dedication and service, Carol is constantly working to improve in her 10 principles of leadership. She would be the first to tell you what she is working on.
I truly believe that Carol's passion stems from a deep concern that exemplifies the mission, vision and values of our Health System.