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

Case Study: AHRQ's RED Toolkit Helps Lower Readmissions in Dignity Health Hospitals
Case Study: Memorial Hospital Uses AHRQ Resources to Cut Readmissions, Promote Patient Self-Management
Case Study: AHRQ's RED Toolkit Inspires Improved Patient Discharge at Nacogdoches Memorial Hospital
Case Study: AHRQ's RED Toolkit Leads to Lower Readmissions, Better Care Transitions in Two Texas Hospitals
Read about lessons learned from implementing RED in ten hospitals across the country in, "How Hospitals Reengineer Their Discharge Processes to Reduce Readmissions" Journal Healthcare Qual 2015 May 13. [Epub ahead of print]

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

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.

Page last reviewed September 2015

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