Project RED (Re-Engineered Discharge)

Internet Citation: Re-Engineered Discharge (RED) Toolkit. April 2016. Agency for Healthcare Research and Quality, Rockville, MD.

http://www.ahrq.gov/professionals/systems/hospital/red/toolkit/index.html

he Project RED (Re-Engineered Discharge) training program was designed to help hospitals re-engineer their discharge process. Using the study modules and supporting materials, hospitals will become familiar with Project RED's processes and components, determine metrics for evaluating impact, and learn how to implement Project RED. This program, developed from an AHRQ project that ran from 2009 to 2012 and based on an early version of the RED Toolkit, has been archived.

Select for the latest version of the RED Toolkit.

Re-Engineered Discharge (RED) Toolkit

Next PageTable of Contents A variety of forces are pushing hospitals to improve their discharge processes to reduce readmissions. Researchers at the Boston University Medical Center (BUMC) developed and tested the Re-Engineered Discharge (RED). Research showed that the RED was effective at reducing readmissions and posthospital emergency department (ED) visits. The Agency for Healthcare Research and Quality contracted with BUMC to develop this toolkit to assist hospitals, particularly those that serve diverse populations, to replicate the RED.

Select for the Taking Care of Myself: A Guide for When I Leave the Hospital, a booklet for patients based on the RED Toolkit.

Related Content

Case Study: Penn Medicine Chester County Hospital Implements AHRQ Toolkit to Reduce Readmissions Case Study: AHRQ's RED Toolkit Helps Lower Readmissions in Dignity Health Hospitals Case Study: Memorial Hospital Uses AHRQ Resources to Cut Readmissions, Promote Patient Self-Management Case Study: AHRQ's RED Toolkit Inspires Improved Patient Discharge at Nacogdoches Memorial Hospital Case Study: AHRQ's RED Toolkit Leads to Lower Readmissions, Better Care Transitions in Two Texas Hospitals Read about lessons learned from implementing RED in ten hospitals across the country in, "How Hospitals Reengineer Their Discharge Processes to Reduce Readmissions" J Healthcare Qual 2016 Mar-Apr;38(2):116-26. Learn how a hospital that participated in AHRQ’s RED Training Program reduced readmissions by 32% in, “Implementation of the Re-Engineered Discharge (RED) toolkit to decrease all-cause readmission rates at a rural community hospital.” Prepared by:

Boston University Brian Jack, MD Michael Paasche-Orlow, MD, M.P.H. Suzanne Mitchell, MD Shaula Forsythe, M.P.H. Jessica Martin, M.A., M.P.H.

Agency for Healthcare Research and Quality Cindy Brach, M.P.P.

Contract No. HHSA290200600012i

Contents

Acknowledgments Tool 1: Overview

  Purpose of the Toolkit
  Reasons To Re-Engineer Your Discharge Process
  Impact of RED
  New and Improved RED Toolkit
  References

Tool 2: How To Begin the Re-engineered Discharge Implementation at Your Hospital

  Purpose of This Tool
  Eleven Steps To Implement the Re-Engineered Discharge
      Step 1: Make a Clear and Decisive Statement
      Step 2: Identify Your Implementation Leadership
      Step 3: Analyze Your Readmission Rates and Determine Your Goal
      Step 4: Identify Which Patients Should Receive the RED
      Step 5: Create Your Process Map
      Step 6: Revise Current Discharge Workflow To Eliminate Duplication
      Step 7: Assign Responsibility for RED Components
      Step 8: Train Discharge Educators and Followup Telephone Callers
      Step 9: Decide How To Generate the After Hospital Care Plan
      Step 10: Provide the RED for Diverse Populations
      Step 11: Plan To Measure the Progress of RED Implementation
  Sample Training Agenda
  References

Tool 3: How To Deliver the Re-Engineered Discharge at Your Hospital

  Purpose of This Tool
  Role of the Discharge Educator
  The After Hospital Care Plan
      What Are the Components of the After Hospital Care Plan?
      What Is the Patient Information Workbook and the RED Workstation?
  Steps To Deliver the In-Hospital RED Components
      Obtain and Review Patient Information From Medical Records
      Confer With the In-Hospital Medical Team
      Arrange To Meet With Patient, Family, and Other Caregivers
      First Meeting With the Patient
  Tool 3 Continued
      Follow Up on Test or Lab Results That Are Pending at Discharge
      Organize Postdischarge Medical Equipment and At-Home Services
      Identify the Correct Medicines and a Plan for the Patient To Obtain Them
      Reconcile the Discharge Plan With National Guidelines
      Teach the Content of a Written Discharge Plan in a Way the Patient Can Understand
      Assess the Degree of Patient Understanding
      Review What To Do if a Problem Arises
  Postdischarge Components of the RED
      Transmit the Discharge Summary to the Postdischarge Clinician
      Provide Telephone Reinforcement of the Discharge Plan
      Staff a Discharge Educator Help Line
  Other Teaching Opportunities Included in the AHCP
  Components of After Hospital Care Plan (AHCP)
  Example After Hospital Care Plan (AHCP)
  AHCP Template for Manual Creation: English-Speaking Patients
  Template for Manual Creation of the AHCP: Spanish-Speaking Patients
  RED Discharge Preparation Workbook
  Contact Sheet
  Examples of Diagnosis Pages

Tool 4: How To Deliver the Re-Engineered Discharge to Diverse Populations

  Purpose of This Tool
  Role of Culture, Language, and Health Literacy in Readmissions
      Culture and Its Relationship to Readmissions
      Language and Its Relationship to Readmissions and Patient Safety
      Health Literacy and Its Relationship to Readmissions
  Preparations for Providing the RED to Diverse Populations
      Hiring Bilingual, Bicultural Discharge Educators
      Providing Cultural and Linguistic Competence Training
      Ensuring Availability of Interpreter and Translation Services
  Overview of Delivering the RED to Diverse Patient Populations
  Getting Started With the RED for Diverse Populations
      Assessing Communication Needs
      Using Nonverbal Communication Styles While Teaching the RED
      Understanding Health Beliefs, Alternative Healers, and Attitudes About Medicines
      Understanding Patients and Communicating Across Differences
  Teaching the AHCP to Patients With Limited English Proficiency
  Using Qualified Medical Interpreters To Create and Teach the AHCP
      Working With Qualified Medical Interpreters
      Accessing Interpreters by Phone and Video
      Handling Patient Refusal of Language Assistance
  Understanding the Role of Family and Community
  Additional Considerations
      Dietary Patterns
      Religious Observances
      Gender Preferences
      Sexual Orientation and Gender Identity
      Mental Health
  References

Tool 5: How To Conduct a Postdischarge Followup Phone Call

  Purpose of This Tool
  Preparing for the Phone Call
      Ensure Continuity of Care
      Learn How To Confirm Understanding
      Review Health History and Discharge Plans
      Check Accuracy and Safety of Medicine Lists
      Identify Problems Patients Could Have With Medicines
      Arrange for Interpreter Services
  Conducting the Phone Call
      Whom and When To Call
      What To Say
  Documenting Your Call
  Communicating With the PCP
  Contact Sheet
  Postdischarge Followup Phone Call Script (Patient Version)
  Postdischarge Followup Phone Call Documentation Form
  Phone Call Role Play

Tool 6: How To Monitor RED Implementation and Outcomes

  Purpose of This Tool
  Getting Started
  Selecting and Specifying Measures
      Implementation Measures
            Is the RED Being Delivered to Target Patients?
            Is the Correct Information Being Collected?
            Is Evidence-Based Care Being Delivered?
            Is Appropriate Followup Care Being Arranged?
            Are Patients Being Prepared for Discharge?
            Are Patients Receiving Postdischarge Care?
            Selecting Implementation Measures
      Outcome Measures
            Hospital Reutilization Measures
            Connections With Outpatient Providers
            Knowledge for Self-Management
            Patient Satisfaction
  Collecting Data
      RED Workbooks and Contact Sheets
      Electronic Health Records and the RED Workstation
      Patient Surveys
  Measurement Timing and Frequency
  Other Means of Monitoring the RED
      Root Cause Analyses
      DE Help Line Logs
      Direct Observation
  Taking Action
  Summary
  Discharge Measures Used by Other Organizations
  How CMS Measures the "30-Day All Cause Rehospitalization Rate" on the Hospital Compare Web Site
  Patient Outcome Survey (mailed version)
  Patient Outcome Survey (phone version)
  References

Tool 7: Understanding and Enhancing the Role of Family Caregivers in the Re-Engineered Discharge To augment the Re-Engineered Discharge Toolkit, Carol Levine and Jennifer Rutberg of United Hospital Fund and Brian Jack and Ramon Cancino of Boston University School of Medicine have developed Tool 7: Understanding and Enhancing the Role of Family Caregivers in the Re-Engineered Discharge Link to Exit Disclaimer (PDF File, 428.5 KB).

The authors of this guide are responsible for its content. The opinions expressed in this document are those of the authors and do not reflect the official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services. Statements in the guide should not be construed as endorsement by the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.

Acknowledgments

We would like to thank the following consultants who gave feedback on earlier versions of this tool: Linda Barnes, MD; William Barron, MD; Frances Bonardi, RN; Erica Dobson, PharmD; Luke Hansen, MD; Steve Martin, MD; Carol Mostow, LICSW; Victoria Parker, DBA; and Jeff Ring, MD

We would also like to thank the hospitals who implemented the RED using an earlier version of this toolkit and provided insights that were used in finalizing the toolkit.

Finally, we thank Carol VanDuesen Lukas, EdD, and Sally Holmes, MBA, from the Boston University School of Public Health for conducting interviews and compiling lessons learned.

http://www.ahrq.gov/professionals/systems/hospital/red/toolkit/index.html