Acute Care/Hospitalization

Discharge process reduces hospital use in the 30 days following discharge

One in five patients discharged from a hospital ends up back at the emergency department or in the hospital within a month because of an adverse event. Thirty percent of these return trips may be avoidable if a hospital standardizes its discharge process to include patient education, coordination with the patient's primary care physician, and pharmacist followup with the patient, a new study finds.

Brian W. Jack, M.D., of the Boston University School of Medicine, studied the effect of a reengineered discharge process with 738 patients discharged from the Boston Medical Center from January 2006 to October 2007. The 370 patients in the intervention group received a personalized after-hospital care plan from a nurse discharge advocate. The advocate also provided the plan and discharge summary to the patient's primary care provider on discharge day. A pharmacist followed up with a phone call to the patient within 4 days after discharge to ensure the patient understood how to take any new medications. The control group of 368 underwent the hospital's regular discharge process.

The reengineered discharge process decreased hospital use by about 30 percent in the 30 days following discharge. Further, patients who underwent the reengineered discharge process were more likely to identify their diagnosis, understand their medication, and visit their primary care physicians within 30 days of discharge compared with patients who received the hospital's regular discharge plan.

The authors demonstrated a cost savings of $412 per discharge using the reengineered process. They suggest that hospitals that institute the new process will benefit by reducing unneeded hospitalizations and attaining a quality improvement target. This study was funded in part by the Agency for Healthcare Research and Quality (HS14289 and HS15905).

See "A reengineered hospital discharge program to decrease rehospitalization: A randomized trial," by Dr. Jack, Veerappa K. Chetty, Ph.D., David Anthony, M.D. M.Sc., and others in the February 3, 2009 Annals of Internal Medicine 150(3), pp. 178-187.

Editor's note: On March 31, 2009, AHRQ hosted a free Web conference on the Re-Engineered Hospital Discharge (Project RED) intervention. To register and view the recorded Web conference, send an E-mail to: Hospital_Technical_Assistance@AHRQ.hhs.gov.

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