Testing the Re-Engineered Discharge

2. “Perfect Storm”of Patient Safety“

3. Principles of the RED:Creating the Toolkit

4. Eleven mutually reinforcing components: ? Medication Reconciliation ? Reconcile Plan with National Guidelines ? Follow-up Appointments ? Outstanding Tests and Studies ? Post-discharge Services ? Written discharge plan ? What to do if a problem arises ? Patient Education ? Assess patient understanding ? Dc summary to PCP > Telephone Reinforcement RED Checklist

10. In Hospital - Discharge Advocate (DA) Nurse Interact with care team – med rec and guidelines Prepare the After Hospital Discharge Plan (AHCP) Teach the AHCP After Discharge – Clinical Pharmacist Follow-up call @ 2-3 days The DA and Pharm manual Scripts for each task Intervention to Administer RED (1) coordinated post-discharge appointments for primary care, consultants, therapy, and outpatient tests; (2) scheduled appointments at times convenient for the subject and informed subject about what to do if an appointment needed to be changed; (3) helped determine a plan for transportation to appointments; (4) obtained pertinent diagnoses from the hospital record; (5) recorded the subject’s preferred outpatient pharmacy; (6) obtained a list of the subject’s discharge medications that were reconciled by the hospital team and updated in the subject’s ambulatory electronic medical record; (7) identified outstanding test results at the time of discharge; and (8) cross-checked the discharge plan with diagnosis-specific guidelines presented in the training manual, discussing possible discrepancies with the medical team before discharge. (1) coordinated post-discharge appointments for primary care, consultants, therapy, and outpatient tests; (2) scheduled appointments at times convenient for the subject and informed subject about what to do if an appointment needed to be changed; (3) helped determine a plan for transportation to appointments; (4) obtained pertinent diagnoses from the hospital record; (5) recorded the subject’s preferred outpatient pharmacy; (6) obtained a list of the subject’s discharge medications that were reconciled by the hospital team and updated in the subject’s ambulatory electronic medical record; (7) identified outstanding test results at the time of discharge; and (8) cross-checked the discharge plan with diagnosis-specific guidelines presented in the training manual, discussing possible discrepancies with the medical team before discharge.

11. Testing the RED Schematic

12. AHCP Evaluation:30 days post-discharge

13. AHCP Evaluation:30 days post-discharge

14. AHCP Evaluation:30 days post-discharge

15. Self-PerceivedReadiness for Discharge 30 days post-discharge

18. RED: Successfully delivered using RED protocols AHCP Improves ‘Readiness for Discharge’ Decreases hospital use 32% reduction NNT = 7.9 Helps high hospital utilizers 40% reduction Is Cost-Effective $329 / patient 38 million discharges @ $753 billion x 32% eligible = 4 billion Conclusions from the RCT

19. Embodied Conversational Agent Teaches the AHCP Emulates face to face communication Develops therapeutic alliance Empathy Gaze, posture, gesture Competency Questions Can drill down in med education Maps of test sites and CHCs Instructions – e.g., Lovenox, Glucometer Workstation database Connects to hospital IT Prints AHCP “Feeds” Louise Concordancy Studies Kiosk for patient access Major Problem: RN TimeCan Health IT Help?

27. Thank You AHRQ!