Project Re-Engineering Discharge Process
Nearly 20% of Medicare hospitalizations are followed by readmission within 30 days, and 90% of these re-hospitalizations within 30 days appear to be unplanned, the result of clinical deterioration. Only 50% of patients re-hospitalized within 30 days had a physician visit before readmission. In addition, 19% of Medicare discharges are followed by an adverse event within 30 days, and 66% of these events are adverse drug events, the kind most often judged to be preventable.
Project Re-Engineering Discharge (RED) is a research group at Boston University Medical Center that develops and tests strategies to improve the hospital discharge process in a way that promotes patient safety and reduces readmissions. The facility participated in the Texas Hospital Association Project RED collaborative sponsored through an Agency for Healthcare Research and Quality grant.
Implementation of Project RED strategies resulting in a cumulative all-cause composite readmission rate of less than 11.5% for acute myocardial infarction, pneumonia, and heart failure patients discharged to home from the 4th and 5th floor.
- Made a clear and decisive statement
- Identified implementation leadership
- Analyzed readmission rates and determined goal
- Identified which patients should receive the RED
- Created process map
- Revised current discharge workflow to eliminate duplication
- Assigned responsibility for RED components
- Trained discharge educators and follow-up telephone callers
- Decided how to generate the “After Hospital Care Plan”
- Provided the RED for diverse populations
- Planed to measure the progress of RED implementation
The composite all-cause 30-day readmission rate for the target Project RED population (acute myocardial infarction, pneumonia, and heart failure patients discharged to home from the 4th and 5th floor) surpassed the goal of less than 11.5%.
- Initial rate: 18.8% (December 2011)
- Cumulative rate: 10.4% (May 2012)
- Represents a 7% decrease during the six-month period
Implementation of Project RED strategies reduced unplanned 30-day readmissions among patients with acute myocardial infarction, pneumonia, and heart failure.