Researchers at Boston University Medical Center have updated a set of steps hospitals can take to reduce readmissions.
The Re-engineered Discharge (RED) toolkit was published by the Agency for Healthcare Research and Quality (AHRQ), which funded the research along with the National Heart, Lung, and Blood Institute. The Boston researchers tested the RED and found them effective at reducing readmissions and visits to the emergency department following discharge.
The RED comprises 12 "mutually reinforcing actions" hospitals can take during and after the hospital stay. The updates include a new component on overcoming language barriers, AHA News reported. It also includes five additional tools with step-by-step instructions and expands on cross-cultural issues and differences in healthcare communication and trust in different communities.
The 12 actions are:
- Determine the need for and obtain language assistance.
- Make appointments for follow-up care including medical appointments and post-discharge tests.
- Plan to follow up on results of tests of labs pending at the time of discharge.
- Organize post-discharge outpatient services and medical equipment.
- Identify the correct medicines and a plan for the patient to obtain them.
- Reconcile the discharge plan with national guidelines.
- Teach a written discharge plan the patient can understand.
- Education the patient about his or her diagnosis and medicines.
- Review with the patient options for dealing with problems.
- Assess the degree of the patient's understanding of the discharge plan.
- Expedite transmission of the discharge summary to clinicians accepting care of the patient.
- Reinforce the discharge plan via telephone.
Test results showed the RED led to a 30 percent reduction in hospitalization utilization within 30 days of discharge and a 34 percent reduction in costs per patient within that same time period.
Some of the accompanying tools address steps needed to implement RED, how to approach diverse populations, how to conduct a post-discharge telephone call and how to monitor implementation and outcomes.
Following the previous RED model helped Chicago's Mount Sinai Hospital cut readmissions over a six-month period from 34 to five without costing any more money or staff, hospital officials reported last year.
RED is one of several initiatives to help hospitals reduce readmission, particularly of Medicare patients with common diagnoses. A recent study published in JAMA Internal Medicine found that predictive analytics can help hospitals predict patients at the highest risk of readmission and proactively intervene to prevent them.
The formula includes what researchers called a "HOSPITAL" score to determine the potential for readmission: hemoglobin at discharge, discharge from an oncology service, sodium level at discharge, procedure during the index admission, index type of admission, number of admissions in the past 12 months, and length of stay.