• C Presnell and A Hutcheson.
• Caldwell Memorial Hospital, Lenoir, NC 28645, USA.
• Jt Comm J Qual Improv. 1997 Feb 1; 23 (2): 79-92.

BackgroundCaldwell Memorial Hospital, a 120-bed not-for-profit community facility in a rural area in western North Carolina, is within a 12-mile radius of three 120-bed skilled nursing facilities. Generally, one-fourth to one-third of its inpatients are from a nursing home. THE NURSING HOME PLACEMENT PROCESS PROJECT: Since 1992 Caldwell has utilized the data-driven, six-step Juran method for its continuous quality improvement (CQI) projects. A CQI team working on social workers' efficiency and visibility recommended that another team begin work on the nursing home placement process. Area nursing homes complained that they were not receiving their fair share of referrals and that transfer documentation was, at times, lacking. THE TEAM ARRIVES AT REMEDIES: The nursing home placement process was streamlined and forms were improved and standardized. A notebook was created and procedures for nursing home placement and for using forms were placed in this notebook. In addition, the team identified and created the long term care fax list, which included all 28 facilities within a 50-mile radius.ImplementationA pilot project involving 23 patients was conducted from July 24, 1995, until August 31, 1995. With successful results, the decision was made to replicate the new nursing home placement process with all other nursing homes. The team held an open house at the hospital.ResultsThere have been no complaints from the nursing homes through 1996. The team spirit that originated during the team time carried over into everyday work, resulting in a better relationship between the hospital and nursing home staffs.

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