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Re-Engineered Discharge (RED) Toolkit | Agency for Healthcare Research & Quality

Re-Engineered Discharge (RED) Toolkit | Agency for Healthcare Research & Quality

AHRQ--Agency for Healthcare Research and Quality: Advancing Excellence in Health Care

Re-Engineered Discharge (RED) Toolkit

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



Tool 1: Overview

   Purpose of the Toolkit

   Reasons To Re-Engineer Your Discharge Process

   Impact of RED

   New and Improved RED Toolkit


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


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


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


   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)

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 Link to Exit Disclaimer (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.


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.
Page last reviewed June 2015
Internet Citation: Re-Engineered Discharge (RED) Toolkit. June 2015. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/systems/hospital/red/toolkit/index.html

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