HeartSMART

Heart SMART is an Ocean Healthcare Network signature program available in several locations, representing a breakthrough in post-acute cardiac care.

The first of its kind in a post-acute setting, HeartSMART provides outstanding treatment for a range of cardiac conditions, including congestive heart failure, post-myocardial infarction, post-coronary artery bypass and valve replacement, and post-cardiac catheter intervention.

The HeartSMART program was developed in conjunction with top cardiac physicians and nurses, and is affiliated with area hospitals. The program is unparalleled in its clinical focus and capabilities, cutting edge equipment, and specially trained staff. Significantly, the program also features extensive and effective patient education, as well as a strong emphasis on preventing hospital readmissions.

Some important features of the Heart SMART Program include:

  • IV Medication

    HeartSMART caregivers, under the general oversight of the Program Advisor, are trained and skilled in the administration of intravenous cardiac medications, including Lasix via IV push. This allows hospitals to discharge their CHF and other cardiac patients to a post-acute setting with confidence.

  • Clinical capabilities

    The Heart SMART program offers the unique combination of outstanding post-acute care and cardiac care, addressing patients' primary cardiac needs as well as their co-morbidities. HeartSMART offers advanced cardiac care programming including CHF, AMI, MI, post-vascular surgery, sternal wound care management, and interventional procedure recovery. The program addresses the complete scope of patient needs, including physical, social, dietary, psychological, and post-discharge healthy lifestyle maintenance. Some of the prominent clinical capabilities include:

  • Cardiac medication management
  • Lasix push
  • Lasix IV drip
  • LifeVest
  • Chest Tube care and management
  • Pleur X Drainage Systems
  • Specially trained staff

    The Heart SMART program’s staff is under the supervision of a cardiologist and is staffed by specially trained caregivers familiar with cardiologist’s and primary physicians’ protocol.

  • Intense patient education

    The Heart SMART program effectively trains patients to recognize the onset of early warning symptoms and to contact their caregivers immediately. Patients are also educated and coached in adapting healthy diet patterns and lifestyles, thus greatly reducing the risk of readmission.

Center for Pulmonary Excellence

The Center for Pulmonary Excellence, currently available at Hampton Ridge Healthcare and Rehabilitation, offers a new level of advanced pulmonary care in a post-acute setting.

The Center was developed in conjunction with top pulmonologists and nurses to provide patients with a high level of care and management for a broad range of pulmonary conditions, such as COPD (Chronic Obstructive Pulmonary Disease), pneumonia, and post-tracheotomy, among others.

The Center for Pulmonary Excellence features a stellar clinical team of experienced caregivers trained in the treatment and protocols specific to this patient population. The Center also features state-of-the-art specialized equipment, advanced clinical capabilities, and a comprehensive patient education/training program that is highly effective in preventing relapses and hospital readmissions.

The Center for Pulmonary Excellence is affiliated with area hospitals, and plays a pivotal role in the continuum of care, supporting patient needs and improving clinical outcomes

Clinical Capabilities

The Center for Pulmonary Excellence provides the full scope of post-acute care services as well as comprehensive pulmonary-specific services with advanced clinical capabilities. Significant among these is the administration of piped-in oxygen with a capacity of 15 liters per minute, enabling clinicians to deliver 100% oxygen to patients as needed. The Center’s care program addresses a wide range of pulmonary needs, with treatment that includes:

  • COPD care
  • Pneumonia care
  • Tracheotomy care
  • Bi-Pap and C-Pap care, management, and patient compliance
  • Peak flow management and supervision
  • Complex medication administration/management, including IV drips and Methylprednisolon (Solu-medrol)
  • Chest Physiotherapy (CPT)
  • Nebulizer/breathing treatments
  • Daily/Weekly respiratory therapy visits
  • Advanced patient and family education

Triple CareTM

Triple Care™ is a revolutionary tele-medicine system that brings physicians to a patient’s bedside – virtually. Triple Care™ uses video technology and digital diagnostic tools to render a pinpoint virtual diagnosis.

The patient is “examined” by qualified Board-certified physician who determines a course of treatment. The entire process is done in close collaboration with the attending nursing staff as well as the patient’s regular physician, resulting in seamless care without the trauma and discomfort of an unnecessary ER visit.

The Triple Care™ Advantage:
  • On-demand care 24/7
  • Avoid unnecessary ER visits
  • Top-quality Board-certified doctors
  • Full collaboration with your physician
Triple Care™ is currently available at South Mountain, Hampton Ridge, and Atlantic Coast.

The Abaqis® Advantage

Even the most skilled and conscientious caregivers can improve their performance and clinical outcomes with the assistance of healthcare technology.

Abaqis® is an advanced quality management system that has been proven to effectively reduce deficiencies and increase quality of care. Developed by Providigm, Abaqis® utilizes the same assessment and investigation tools that surveyors employ in the Long-Term Care Survey Process (LTCSP).

The interactive system demands input and feedback from caregivers, staff, residents, and family members. Abaqis® seamlessly integrates into the MDS system to accurately compile admission and discharge data on each patient including payor, diagnosis, hospital, practitioner/physician, day of week, shift, number of days post admission.

Based on this and other factors, Abaqis® enables clinicians to pinpoint potential areas of non-compliance, identify root causes of potential deficiencies, follow readmission trends, and implement effective corrective plans. Post-Acute centers in the Ocean Healthcare Network all employ the Abaqis® system, and have found that the program is an invaluable and powerful tool for QAPI initiatives.

DirectLine

Since Ocean Healthcare Network facilities accept admissions 24/7, they maintain a common Readmission Hotline providing trained Patient Care Coordinators standing by to accept qualifying admissions24/7. The service, known as DirectLine, is the only one of its kind marketed directly to Emergency Room personnel as a valuable resource. DirectLine enables ER staff to avoid readmissions by directing clinically appropriate patients to be treated in one of Ocean Healthcare’s post-acute facilities.

In addition to processing admissions around the clock, Ocean Healthcare Network members also accept patient referrals 24/7. This facilitates patients’ expedited discharge from hospitals and reduces the overall costs of healthcare reimbursement.

Transitional Care Coordination Program

This signature Ocean Healthcare Network program has made a significant impact in readmission reduction and improved clinical outcomes.

To ensure that patients discharged from a Skilled Nursing facility are receiving proper care, Ocean Healthcare Network members collaborate to provide care options such as Home Health Care, Home-Based skilled Nursing, Adult Day Health Services, Assisted Living Communities, and Hospice Care. The providing caregivers work in tandem with the discharging facility to thoroughly understand the patient’s history and meet their specific care needs.

The Transitional Care Coordination Program effectively bridges the care gaps that commonly lead to the incidence of unnecessary hospital readmission, namely: medication complications, insufficient home health care, inadequate durable medical equipment, and lack of follow-up physician/medical care.

Patients are provided with clear instruction and guidance at the time of discharge. A designated Care Coordinator provides extensive follow-up after the patient is at home to ensure that the patient’s medications, home environment/care, equipment, and medical oversight are thoroughly addressed.