Reducing Unnecessary Readmissions: The New RED (Re-Engineered Discharge) Tool

Dr. Michael Paasche-Orlow discussed ways to reduced hospital readmissions. He focused on what Boston University Medical Center has done to lower these rates. He noted that under the Affordable Care Act (ACA), there are incentives for hospitals to avoid rehospitalization. The goal of avoiding rehospitalization is to improve quality and decrease cost, he said.

Hospital discharges are not standardized and are frequently of poor quality. Too often, pending test results are not followed, workups are not completed, and communication is poor. This leads to lack of follow-up care, adverse events, and readmission. This is especially true for patients with poor communication skills, he said.

“We used talk about fee for service; now we talk about fee for value,” he said. “Literacy is a part of that story. There’s a lot of work to be done to transform our organizations.”

Dr. Paasche-Orlow shared the National Quality Forum’s Re-Engineered Discharge checklist:

• Ascertain need for and obtain language assistance.
• Make appointments for follow-up care.
• Plan for follow up of results from pending tests.
• Organize post discharge services and equipment.
• Identify correct medicines and plan for patient to obtain.
• Reconcile discharge plan with national guidelines.
• Teach a written discharge plan that patient can understand.
• Reconcile discharge plan with National Guidelines.
• Educate patient about diagnoses and medicines.
• Assess degree of patient’s understanding of plan.
• Expedite transmission of discharge summary to primary care provider.
• Reinforce through telephone contact.

Studies have found that using the RED checklist is effective and saves money and he offered illustrations of how to put these items into effect.

Transforming a system takes time, and when introducing teachback, “you have to actually supervise it, observe it, and offer feedback.” When working to transform the system, Dr. Paasche-Orlow encouraged attendees to find people who will embrace the work and engage patients.