Patient Safety, 2010

Society of Hospital Medicine

July 2010

The Society of Hospital Medicine developed a hospital discharge toolkit based on findings from two AHRQ-funded projects—Patient Safe-D(ischarge) and Project RED (Re-Engineered Discharge). The toolkit, called Project BOOST (Better Outcomes for Older Adults through Safer Transitions), has been used by approximately 45 hospitals nationally to implement an evidence-based method of better organizing and standardizing the sometimes chaotic patient discharge process. The Society of Hospital Medicine is a national organization representing more than 10,000 hospitalists—physicians who practice in hospitals.

According to Mark V. Williams, MD, FACP, FHM, Principal Investigator for Project BOOST and Professor and Chief, Division of Hospital Medicine at Northwestern University Feinberg School of Medicine, "AHRQ's investment in the Patient Safe-D and Project RED provided invaluable experience and yielded important components for the more expansive Project BOOST initiative. Much of the Project BOOST toolkit came directly from this earlier effort."

Project BOOST helps hospitals reduce readmission rates by providing clinicians with proven resources and expert mentoring to improve the discharge transition process, enhance patient and family education, and improve the flow of information among inpatient and outpatient providers.

Early results from some BOOST programs nationwide are promising. At Piedmont Hospital in Atlanta, there was an approximately 40 percent decrease in the readmission rate related to the BOOST intervention among patients younger than 70. When SSM St. Mary's Health Center in St. Louis implemented BOOST in its hospitalist unit, unplanned 30-day readmissions dropped from 12 percent to 7 percent between July and September 2009. Patient satisfaction rates also increased by 42 percent at St. Mary's in the same period. These rates were measured by the Hospital Consumer Assessment of Healthcare Providers and Systems, a standardized survey instrument to measure and collect patients' perspectives of hospital care.

"Mark Williams' AHRQ grant allowed him to test the clinical interventions," notes Tina Budnitz, MPH, a senior advisor for the Society of Hospital Medicine. "This evidence-based toolkit offers both a comprehensive intervention and a step-by-step guide for clinician teams to implement system-level changes. We have found that change-management issues are the area in which teams need the most guidance."

The Project BOOST toolkit is available at http://www.hospitalmedicine.org/ResourceRoomRedesign/RR_CareTransitions/CT_Home.cfm.

Impact Case Study Identifier: CQuIPS-10-02
AHRQ Products: Partnerships in Patient Safety
Topic(s): Patient Safety
Scope: National

Greenwald JL, Denham CR, Jack BW. The hospital discharge: a review of high-risk care transition with highlights of a reengineered discharge process. J Patient Saf 2007;3(2):97-106.

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