AHRQ’s RED Toolkit Inspires Improved Patient Discharge at Nacogdoches Memorial Hospital

Nacogdoches Memorial Hospital, a 216-bed Level III trauma center in Nacogdoches, Texas, saw 30-day all-cause readmissions drop from 18.6 percent to 16.6 percent in the six-month period after implementing AHRQ's Re-Engineered Discharge (RED) toolkit.

Introduced July 1, 2012, the RED toolkit has helped reduce the hospital's readmission rate and built momentum among clinicians to improve the patient discharge process, said Jessica Stewart, M.S., B.S.N., R.N., director of quality improvement.

"RED is having a positive impact, and it is ensuring interdisciplinary interaction with all the departments, from medical staff, utilizations, nursing, quality, and discharge planning," Ms. Stewart said. "Everyone is coming together to work on patient discharge. I'm proud of it."

Developed by AHRQ-funded patient safety researchers in Boston, the toolkit provides evidence-based tools to help hospitals re-engineer patient discharge processes. RED interventions are focused on comprehensive discharge planning, patient education about hospital discharge, and post-discharge patient follow-up. By designating discharge advocates who help patients reconcile their medicines and schedule follow-up appointments with their primary care physicians, hospitals can reduce avoidable readmissions. Nearly 20 percent of Medicare patients are readmitted to the hospital within 30 days of discharge.

Nacogdoches Memorial administrators decided to work on improving discharge processes in 2012 as high hospital readmission rates became a national concern. An added incentive: then-looming Medicare payment reductions for hospitals whose readmission rates for heart attack, heart failure, and pneumonia exceeded national averages.

"Our numbers weren't that good," said Ms. Stewart. Shortly after implementing RED, the East Texas hospital hired a nurse, who was designated as the hospital's discharge advocate. The hospital introduced the teach-back method around patient medications, made follow-up calls to patients within days of their discharge, and scheduled doctors' appointments on patients' behalf. RED was initially rolled out in the intermediate care and medical surgical units and then expanded to the surgical, intensive care, and pediatric units.

Nacogdoches Memorial has worked to refine its patient discharge process by increasing interaction between physicians and social workers. The hospital also provides discharged patients in need with certain medicines and transportation to two follow-up medical appointments. Nacogdoches has also educated staff at area skilled nursing facilities about care transitions in order to help lower hospital readmission rates.