More and more, researchers are going back to the basics to improve health care. Tools as simple as checklists are making a real difference because they challenge us to scrutinize very complicated processes and break them down into deliberate, manageable tasks. In creating Project RED, or the Reengineered Discharge, Boston University Medical Center's Dr. Brian Jack went through the soup to nuts of discharging patients from the hospital with a goal of reducing preventable readmissions. In the end, the research team came up with an innovative approach for changing the way we discharge patients from our Nation's hospitals.
Project RED's principles are simple and clear:
- Well-defined roles and responsibilities for everyone on the health care team.
- Easy flow of information from the hospital team and the patient's regular doctor.
- Patient education throughout the hospital stay.
- A printed, easy-to-understand discharge plan for the patient.
Project RED's results have been dramatic. Dr. Jack's team documented a 30 percent reduction in readmissions and emergency room visits as well as high rates of patient satisfaction with the discharge process. For example, 87 percent of those in the study said they knew which appointments they still needed to make, compared with 79 percent of patients who did not participate. Two-thirds of the study group said they understood the main reason why they were in the hospital, compared with 57 percent of nonparticipants. Finally, a larger percentage of patients (89 percent) who took part in Project RED said they understood their medications after leaving the hospital compared with those who did not participate in the study (83 percent).
Project RED ensures that the treatment team not only communicates better within the hospital's walls, but also reaches out to patients' regular primary care providers to provide updates and schedule followup appointments for patients. This followup is crucial, because AHRQ research shows that more than one-third of patients who leave the hospital don't get the followup care they need, like lab tests or a referral to see a doctor who specializes in their condition. We're hoping Project RED is a fix for this problem.
Project RED's designers also appreciated that patients are often more excited about leaving the hospital than focusing on all the components of their discharge plan. That's why a member of the treatment team will call to check in with patients a few days after discharge to make sure they are following their medication schedules or to remind them about upcoming medical appointments. This call also gives patients an opportunity to ask additional questions and get clarification on anything they might have missed or misunderstood during the discharge.
At AHRQ, we know that engaging patients as active partners in their care is a critical component of providing high-quality care. Project RED's unique blend of patient education and treatment team coordination is truly an example of an innovation that can make a real difference in patient outcomes and lives.
Carolyn M. Clancy, M.D.
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