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Guideway Care Success Stories

Improved Bundle Performance

The Challenge

This Mid-Atlantic urban medical center needed help lowering readmissions for patients included in the BPCI-A bundle.

Guideway’s Solution

Care guides performed outreach to identify and document potential issues and resolve any barriers. While all patients covered by the bundle were included in the program, pneumonia and sepsis patients were prioritized because of the high-risk of readmission associated with the two conditions.

Results Delivered

On average, navigated patients were 49% less likely to readmit than non-navigated patients. Readmission rates for pneumonia patients reduced by more than 48 percent; sepsis patient readmissions reduced by more than 58 percent.

Readmission reduction by target condition:

Sepsis: Reduced Readmissions by 58%
Pneumonia: Reduced Readmissions by 48%

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Patient Vignette

Driving Clinical Escalation

On a Wednesday, the patient stated that she was in pain and experiencing swelling in her abdomen. Her abdominal procedure was not scheduled for a few weeks. The Care Guide connected with the clinic’s nurses, and the patient received a same-week appointment.

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