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Re-Engineered Discharge (RED) Toolkit

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 Project RED (Re-Engineered Discharge) Training Program.

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

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 (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.

Current as of May 2014
Internet Citation: Re-Engineered Discharge (RED) Toolkit. May 2014. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/systems/hospital/red/toolkit/index.html