Reducing Readmission using the Re-Engineered Discharge: A Quality Improvement Project—Evaluation and Analysis

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Introduction/Purpose: One out of every five patients hospitalized for heart failure (HF)- related complications are readmitted within 30 days of previous admission. Readmission, as a healthcare quality index, provides a metric to investigate strategies to improve HF outcomes. The Re-Engineered Discharge (RED) protocol is a comprehensive transitional care tool created to improve overall patient outcomes and self-efficacy. The purpose of this quality improvement project was to evaluate the RED protocol’s effect on readmission rates in patients admitted with HF at a small, Midwestern hospital.

Methods: This project used a convenience sample of adult patients, ages 18 years or older admitted to the hospital with HF during a 60-day period. All patients (N = 7) who met the sample criteria received the RED transitional care protocol delivered by a trained cardiac care nurse. Following the implementation, the researcher performed a chart audit over 30 days to identify readmission status, collect data, and verify the integrity of RED implementation.

Results: The readmission rate was 28.6% among the study group, which was above the hospital’s baseline rate of 25.42% in August. The readmission index was 0.91 in the study group versus the hospital’s overall index (1.07). The findings regarding the secondary data was consistent with the literature results that demonstrated increased HF incidence among older adults (age range, 58 - 91), females (four females versus three males), and increased occurrence in higher socio-economic status persons. The most common secondary diagnoses were hypertension (N = 7), osteoarthritis (N = 4), hyperlipidemia (N = 4), atrial fibrillation (N = 3), and diabetes mellitus (N = 3). The protocol fidelity was 100% for all steps, except for the follow up phone call (78%), validated through self-report and chart audit.

Discussion: The project does not statistically support use of the RED protocol as a means of reducing readmission; however, the literature continues to support the individual steps of the protocol. Further study is necessary to validate the protocol. This project sought to inform transitional care guidelines in acute care institutions to improve patient outcomes and reduce readmission.

DNP project