Last week I talked about some of the reasons why you should improve your emergency department discharge process. It’s one hospital quality measure that can affect your patient satisfaction scores and HCAHPS scores. Making sure your process is in order won’t just improve quality of care and patient outcomes -- it can also help you earn “top-box” HCAHPS status. As a result, you can earn higher Medicaid and Medicare reimbursements in this era of value based care.
Proven Process Improvement Borrowed From Outside Industry
Luckily, the government has funded a toolkit to help hospitals implement best practices in regards to discharge. The Re-Engineered Discharge toolkit, or RED for short, took seven years to create. When it comes to finding new and better ways to operate, I’ve touted the benefits of looking outside of the healthcare space to business or other industries for methodologies like Six Sigma before. It turns out the government did just that in creating the RED toolkit.
From the Agency for Healthcare Research and Quality (AHRQ): “Preliminary work included intensive study of the discharge process, borrowing methodologies from engineering to define the RED, such as process mapping, failure mode effect analysis, probabilistic risk assessment, root cause analysis, and qualitative analysis.”
The result requires hospitals to act with discharge in mind throughout the patient flow process including conducting follow-up after the patient leaves your facility. The RED has been mentioned to be of particular value for hospitals serving diverse populations
Lower Costs and Improve Outcomes
The AHRQ says the benefits of using the kit are clear -- among them it improves outcomes and return on investment. It can:
Decrease 30-day readmission by 25 percent.
Decrease ED use from 24 percent to 16 percent.
Reduce costs by $412 per patient.
As a bonus it is “accepted as NQF Safe Practice and endorsed by Institute for Healthcare Improvement, The Leapfrog Group for Patient Safety, and CMS.”
Published Positive Results
But is it feasible to implement? A study published online this May from the Journal for Healthcare Quality looked at 10 hospitals before and after they implemented RED and the results were positive. “Eight out of 10 hospitals reported improvement in 30-day readmission rates after RED implementation,” found the authors.
They also found that while a supportive hospital culture is essential and “engaged leadership and multidisciplinary implementation teams were keys to success” -- hospitals could be flexible in their implementation strategy.
Researchers found that common challenges included: obtaining timely follow-up appointments, transmitting discharge summaries to outpatient clinicians, and leveraging information technology.
Your 12-Point Discharge Improvement Plan
The AHRQ says the “RED consists of a set of 12 mutually reinforcing actions to ensure a smooth and effective transition at discharge.” I like to think of it almost as a checklist. Take a look and see what you think. From the AHRQ:
Components of the RED
Ascertain need for and obtain language assistance.
Make appointments for followup care (e.g., medical appointments, postdischarge tests/labs).
Plan for the followup of results from tests or labs that are pending at discharge.
Organize postdischarge outpatient services and medical equipment.
Identify the correct medicines and a plan for the patient to obtain them.
Reconcile the discharge plan with national guidelines.
Teach a written discharge plan the patient can understand.
Educate the patient about his or her diagnosis and medicines.
Review with the patient what to do if a problem arises.
Assess the degree of the patient's understanding of the discharge plan.
Expedite transmission of the discharge summary to clinicians accepting care of the patient.
Provide telephone reinforcement of the discharge plan.
Ready to make some of these changes? Head on over to the online toolkit. They have printable PDFs that your team and patients can fill out. Or for expert help facilitating a re-engineering of your discharge or any other process within your emergency department, contact me. My healthcare consulting agency, Donovan and Partners, can do an assessment of your emergency department. It can help you hone in on opportunities across multiple processes that can help boost your patient satisfaction and HCAHPS scores.
AHRQ: “Re-Engineered Discharge (RED) Toolkit.”
HCAHPS: “HCAHPS Tables on HCAHPS Online.”
The Journal for Healthcare Quality, “How Hospitals Reengineer Their Discharge Processes to Reduce Readmissions.” Mitchell, SE. Online May 13, 2015.