project red the re-engineered discharge jcr’s ahrq-funded project august 2010 deborah nadzam susan...

Project RED The Re-Engineered Discharge

JCR’s AHRQ-funded Project

August 2010

Deborah Nadzam

Susan Whitehurst

Project RED ChecklistEleven mutually reinforcing components:

1. Medication reconciliation 2. Reconcile discharge plan with national guidelines 3. Follow-up appointments 4. Outstanding tests 5. Post-discharge services 6. Written discharge plan 7. What to do if problem arises 8. Patient education 9. Assess patient understanding10. Discharge summary sent to PCP11. Telephone reinforcement

Adopted by

National Quality Forum

as one of 30 US

"Safe Practices" (SP-15)

11 RED Components Enable 11 RED Components Enable Discharge Advocates to:Discharge Advocates to:

Prepare patients for hospital discharge

Help patients safely transition from hospital to home

Promote patient self-health management

Support patients after discharge through follow-up phone call

Project Expectations

Secure executive sponsorship Assign project team and project leader Identify targeted population of patients* Determine approach for generating After

Hospital Care Plan (ACHP)* Identify discharge advocate(s) and staff

to make post-discharge phone calls Participate in focus group conference call

Project Expectations cont’d

Participate in training Schedule bi-weekly consulting calls with

assigned JCR consultant Provide data to JCR re: readmission,

ALOS Participate in all-site web conference

discussions Participate in case-study interviews

Current Status

30 participants– Proceeding with training and implementing

20 more expected to enroll Possible additional AHRQ funding to

support 75 more hospitals

Project RED Training

Course designed and available to participants via JCR’s BlackBoard

Recorded webinars, with homework!– Module 1 – Designing a strong PI program

– Module 2 – Operationalizing Project RED (A)

– Module 3 – Operationalizing Project RED (B)

Live Module 4 – content and open discussion Several handouts and tools

After Hospital Care Plan

Ready for Project RED?

Next Steps– Secure leadership commitment

– Identify targeted populations to begin

– Determine approach for developing After Hospital Care Plan

– Identify staff: Project Leader, Project Team, Discharge Advocate(s)

Identify Targeted Patient Population

Start small! Approaches to consider

– Specific patient care unit

– Diagnostic group

– Physician’s patient group

– Combination of above

Also– English-speaking patients

– Discharged home

– Access to telephone

Developing the Patient’s Care Plan

Accessing the care plan template

Accessing information for the care plan

Saving individual patient’s care plan

Printing the care plan Storing the care plan

– Permanent part of the patient record?

Care Plan Development

Generating the AHCP

“Manual” – use of template for discharge advocate (DA) to enter all required data

www.ahrq.gov/qual/goinghomeguide.htm Provide template to your IT department

and request that they integrate with existing systems

Purchase software and integrate it with your existing systems

To participate in JCR’s AHRQ-funded project focused on

Project RED

Contact Deborah Nadzam

dnadzam@jcrinc.com

630-261-5048