Rationale / Objectives
The transfer of patient care from the Euclid hospital team to primary care and other health care providers in the community at the time of discharge was a high-risk process characterized by fragmented, non-standardized, and haphazard care that led to errors and adverse events.
The Euclid Hospital had a high readmission rate for heart failure patients after discharge, especially from one specific nursing home. The high readmission rate to Euclid Hospital was due to: delayed transfer of discharge summary to the primary care provider, unknown test results and lack of follow-up due to patients’ insufficient understanding about their health problem, inaccessibility to their doctor or confusion about their medications.
The Euclid hospital wanted to improve: their discharge processes to reduce readmissions and post hospital emergency department (ED) visits, care transition by coordinating patients’ appointments following discharge and educating patients about their diagnosis and medications. 1 2 3
Project/Program Description & Major Achievements
Euclid hospital staff members implemented Re-Engineered Discharge (RED) toolkit. The RED consists of a set of 12 mutually reinforcing actions, that the hospital undertakes during and after the hospital stay to ensure a smooth and effective transition at discharge.
Patients who received the RED experienced the following: 30% lower rate of hospital utilization within 30 days of discharge compared to patients receiving usual care, decreased ED use from 24% to 16% and one readmission or ED visit was prevented for every seven patients receiving the RED. Further, the RED patients cost an average of $412 less in the 30 days following hospital discharge than patients who did not receive the RED. This represents a 33.9% lower observed cost for this group. 1
The implementation of RED toolkit in Euclid hospital increased patient satisfaction, as most patients appreciated the personal approach and welcomed the calls. Of the 10 Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient experience questions, Euclid Hospital outperformed the national average on seven questions.1
People / Organizations Involved
Initially, the Euclid Hospital implemented the RED Toolkit with one physician who treated patients who had heart failure. Within the first month, the team noticed a higher number of readmissions from a particular nursing home and expanded the program to include patients discharged to that nursing home. Based on the success of that pilot project, the hospital expanded RED to all heart failure patients, all inpatient units and all physicians. Staff members are now implementing such key components of RED as scheduling follow-up physician appointments for discharged patients and calling patients within 48 hours to check on them and to answer questions. While in the hospital, a registered nurse appointed as a care advocate sees heart failure patients by the second day of admission. The nurse reviews medications, helps patients understand their medication routine, and ensures they can afford their medications or obtain less costly ones. RED also implemented the teach-back method for educating inpatients about their diagnosis and appointing a nurse practitioner and a health coach to oversee the discharge team. 1 3
|rate of hospital utilization within 30 days of discharge in patients who received the RED.||30% lower rates than other patients.||RED Toolkit case study.|
|ED use.||Decreased from 24 %to 16 %.|
|Readmission or ED visits preventions in patients who received the RED.||1 for 7 patients.|
|30-day readmissions for those nursing home patients involved in the study.||Dropped from 21% to 5%.|
|HCAHPS scores.||outperformed the national average on seven questions.|
|Costs in the 30 days following hospital discharge in patients receiving RED.||33.9% less ($412 less).|