- Phone:
- (812) 855-1728
- Email:
- dreising@iu.edu
- Campus:
- IU Bloomington
Project abstract
The Navigator program is an innovative practice-academe model that prepares future nurses and physicians across the continuum of care. The model involves the transitional care nurse at a regional health care organization, and nursing and medical student teams at Indiana University Health Bloomington. The patient population includes those who are at high risk for readmission after discharge from acute care.
After the transitional care nurse makes an initial home visit, interprofessional student navigator teams make subsequent home visits. Supervised by an Emergency Department direct care nurse, student navigator teams work collaboratively with one another, implementing patient-centered care, to facilitate communication across providers.
Home visits include focused assessments, based on the initial home visit findings, and the discharge plan of care. Teams provide education to reinforce important self-monitoring, dietary considerations, resource acquisition, and appointment adherence. Patients in the program experienced a reduction in 30-day re-admission rates from 27.45% to 1.96%; a reduction in all admissions from 60.78% to 31.37%. Cost avoidance to the health care system has reached over $1,000,000 over the first 5 years of the program.
Student teams learn how their care adds value to the health care system, fostering key leadership and collaboration skills.
Campus partners
- Schools of Nursing and Medicine
Community partners
- Indiana University Health Bloomington
Counties involved
Lawrence, Orange, Owen, Monroe, Greene