Impact of AHRQ Re-Engineered Discharge Toolkit on Adult Patient's 30-Day Readmission.

Abstract

Purpose of study: The aim of this quality improvement (QI) project was to determine whether implementing the Agency for Healthcare Research and Quality (AHRQ) Re-Engineered Discharge (RED) Toolkit would impact 30-day readmissions among adult medical-surgical patients in an urban Arizona hospital over 8 weeks. This quality improvement project aims to address the lack of evidence-based practice (EBP) discharge guidelines at the project site and to improve readmissions by translating research evidence into clinical practice.

Primary practice setting: The project site is a single medical center within a hospital system located in an urban area of Arizona.

Methodology and sample: The medical-surgical nurses utilized the AHRQ RED components in the form of a discharge checklist. Education and staff teaching were conducted at the project site, with stakeholders provided with EBP resource materials, including the AHRQ's RED Toolkit and scientific evidence on how this process can impact hospital 30-day readmissions. This checklist incorporates the 11 RED components of the discharge process. The checklist served as a procedural guide for nurses during discharge.

Results: Patient data were collected to measure the impact of the AHRQ RED Toolkit on 30-day readmissions. Data were collected from the electronic health record and EBP tool, the AHRQ RED checklist. Thirty-day readmissions were measured as counts in a sample of 307 patients, with data collected before intervention (n = 199) and again after intervention (n = 108). The frequencies of 30-day readmissions were described using counts and percentage rates, then compared using Pearson's chi-square test. In the comparison patient group, there were 99 readmissions (50%) out of 199 patients. In the intervention patient group, 24 patients (22%) out of 108 were readmitted. Pearson's chi-square test showed a statistically significant difference in the number of patients readmitted within 30 days of discharge [X2(1, N = 307) = 22.0; p = .001).

Implications for case management: The AHRQ RED components are evidence-based discharge interventions and strategies that have been proven to be crucial in reducing readmissions and improving patient outcomes. The project results highlight the importance of incorporating EBP guidelines into health care settings and validate the effectiveness of these interventions in bridging gaps in patient care, such as avoidable readmissions. The project outcomes demonstrate the role of the RED components in guiding case managers during a patient's hospital discharge. Applying the RED components was essential in preventing readmissions, thereby influencing health care and case management practices, including ensuring safe discharges, reducing costs, and improving care quality. The project outcomes showed significant improvements in the discharge process, providing opportunities to develop a new discharge protocol. This supports the decision to incorporate this checklist into the standard of care during discharges. Additionally, the positive results open the possibility of integrating the discharge checklist into the electronic health record system for a larger-scale impact. The project outcomes, which are both clinically and statistically significant, can help the case management community consider integrating AHRQ RED components into patient care coordination and discharge planning as patients transition to their homes.