RED Lowering Hospital Readmissions and Improving Patient Satisfaction at Euclid Hospital in Ohio

Two years after introducing AHRQ's Re-Engineered Discharge (RED) toolkit and seeing patient satisfaction improve and avoidable heart failure readmissions decrease, Euclid Hospital, a Cleveland Clinic facility in Euclid, Ohio, has taken RED hospital-wide. In addition, Cleveland Clinic has now incorporated pieces of the intervention throughout its system to reduce hospital readmissions.

"We saw really good results with RED," says Vickie Gardner, R.N., Euclid Hospital's Coordinator for Nursing Quality and Accreditation. "It gave us the opportunity to work with other organizations—including 11 area nursing homes—and establish best practices."

RED, a toolkit originally developed by AHRQ-funded patient safety researchers in Boston, provides evidence-based tools to help hospitals re-engineer their patient discharge processes. By designating discharge advocates who help patients understand their medications and schedule follow-up appointments with their primary care physicians, hospitals can reduce readmissions.

Initially, Euclid Hospital staff implemented RED with one physician who treated patients with 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.

According to Ms. Gardner, the team met with the nursing home staff to share best practices on helping reduce readmissions for heart failure patients. The nursing home staff was receptive to being included in the project, because "they feel like we are a team," she says. "That team participation makes the difference."

After six months, 30-day readmissions for those nursing home patients dropped from an average of 21 percent to 5 percent. Euclid Hospital also saw an improvement in scores on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) after the role of discharge advocate (called a care advocate at Euclid Hospital) was added.

Based on the success of that pilot project, the hospital expanded RED to all heart failure patients. The hospital now hopes to reduce the readmission rate for all heart failure patients to less than 20 percent, says Ms. Gardner. The United States national rate of readmission for heart failure patients is 23 percent, according to Medicare's Hospital Compare Web site.

Euclid Hospital has also expanded elements of RED beyond heart failure patients to 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 their inpatient stay, reviews medications, helps patients understand their medication routine, and ensures they can afford their medications or helps them obtain less costly ones. In addition, "We make sure patients have transportation" to follow-up appointments or the pharmacy, Ms. Gardner notes.

The larger effort that includes a care advocate role has since been adopted by several other Cleveland Clinic hospitals in Ohio. The care advocates from each facility meet regularly to discuss the continuum of care for heart failure patients from admission through discharge planning.

"RED gave us a really good starting point" on reworking the discharge process, Ms. Gardner says. "It got us going on the right track."

The effect on patients has been clear and positive. Ms. Gardner says most patients appreciate the personal approach and welcome the calls. "They appreciate that you are giving them the time they need. It prompts patients to ask questions that they otherwise might not," she explains.

Of the 10 HCAHPS patient experience questions, Euclid Hospital outperformed the national average on seven questions. For example, 91 percent of Euclid patients reported that they were given information about what to do during their recovery at home compared with 85 percent of hospital patients nationally. "I know we are making a difference in patients' lives," Ms. Gardner says.