Supportive Culture Essential to Re-Engineered Discharge Implementation, Study Finds

A supportive hospital culture is essential for successful implementation of AHRQ’s Re-Engineered Discharge (RED) toolkit, while a flexible strategy can be used to implement RED and reduce avoidable readmissions, according to a new study. RED is a proven hospital discharge planning method that consists of 12 components, including medication reconciliation and making sure patients have scheduled follow-up primary care visits. The study describes the RED Toolkit, implementation challenges hospitals face and ways these barriers can be mitigated. Researchers recruited 10 hospitals to implement RED and provided training for participating hospital leaders and staff using the RED Toolkit. They identified common challenges and found that implementation of RED varied widely and that engaged leadership and multidisciplinary teams were keys to success. The article and abstract, “How Hospitals Reengineer Their Discharge Processes To Reduce Readmissions,” appeared in the May 13 issue of the Journal for Healthcare Quality.

2015 May 13. [Epub ahead of print]

How Hospitals Reengineer Their Discharge Processes to Reduce Readmissions.

Mitchell SE, Martin J, Holmes S, van Deusen Lukas C, Cancino R, Paasche-Orlow M, Brach C, Jack B.

Abstract

BACKGROUND:

The Re-Engineered Discharge (RED) program is a hospital-based initiative shown to decrease hospital reutilization. We implemented the RED in 10 hospitals to study the implementation process.

DESIGN:

We recruited 10 hospitals from different regions of the United States to implement the RED and provided training for participating hospital leaders and implementation staff using the RED Toolkit as the basis of the curriculum followed by monthly telephone-based technical assistance for up to 1 year.

METHODS:

Two team members interviewed key informants from each hospital before RED implementation and then 1 year later. Interview data were analyzed according to common and comparative themes identified across institutions. Readmission outcomes were collected on participating hospitals and compared pre- versus post-RED implementation.

RESULTS:

Key findings included (1) wide variability in the fidelity of the RED intervention; (2) engaged leadership and multidisciplinary implementation teams were keys to success; (3) common challenges included obtaining timely follow-up appointments, transmitting discharge summaries to outpatient clinicians, and leveraging information technology. Eight out of 10 hospitals reported improvement in 30-day readmission rates after RED implementation.

CONCLUSIONS:

A supportive hospital culture is essential for successful RED implementation. A flexible implementation strategy can be used to implement RED and reduce readmissions.