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 UniversityBrian Jack, MDMichael Paasche-Orlow, MD, M.P.H.Suzanne Mitchell, MDShaula Forsythe, M.P.H.Jessica Martin, M.A., M.P.H.Agency for Healthcare Research and QualityCindy Brach, M.P.P.Contract No. HHSA290200600012iContentsAcknowledgmentsTool 1: Overview Purpose of the Toolkit Reasons To Re-Engineer Your Discharge Process Impact of RED New and Improved RED Toolkit ReferencesTool 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 ReferencesTool 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 PagesTool 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 ReferencesTool 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 PlayTool 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) ReferencesThe 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.AcknowledgmentsWe 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, MDWe 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 March 2013 Internet Citation: Re-Engineered Discharge (RED) Toolkit. March 2013. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/systems/hospital/toolkit/index.html
Back
