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Resources for Reducing Unnecessary Hospital Readmissions

The information below can be used by Patient Safety Organizations (PSOs), hospitals, or clinicians to reduce unnecessary readmission rates in their facilities

Tools & Resources

Before selecting a tool to implement, a hospital may wish to study its readmission history and evaluate the potential causes and appropriateness of recent readmissions.

Common Formats – A new Common Format, the Common Format – Readmissions Version 0.1 Beta, is now available. This was developed by AHRQ in collaboration with the interagency Federal Patient Safety Work Group. For information on AHRQ's Common Formats, go to: http://www.pso.ahrq.gov/formats/commonfmt.htm.

ProjectRED (Re-Engineered Discharge) is a free toolkit that can reduce readmissions by integrating better communication among clinicians and patients and by instituting followup after discharge. Developed in a safety-net hospital with AHRQ funding, ProjectRED is now used effectively in many hospital settings. For more information, go to: http://www.ahrq.gov/qual/impptdis.htm.

Project BOOST (Better Outcomes for Older Adults through Safe Transitions) includes resources to reduce readmissions in the elderly population. The Society for Hospital Medicine offers free quality improvement resources, and individual consultation and technical assistance for a fee. Select for more information: http://www.hospitalmedicine.org/AM/Template.cfm?Section=Home&TEMPLATE=/CM/HTMLDisplay.cfm&CONTENTID=27659

Colorado Foundation for Medical Care, a resource center on community-based transitions in care, offers a number of tools to improve care transitions. The site is searchable. For more information, go to: http://www.cfmc.org/integratingcare/

Toolkit for a community-based care transitions program: http://www.cfmc.org/integratingcare/toolkit.htm
Care transition tools: http://www.cfmc.org/integratingcare/provider_resources.htm
Patient education materials: http://www.cfmc.org/integratingcare/patient_resources.htm

MATCH Toolkit (Medications At Transitions and Clinical Handoffs) helps hospitals improve medication reconciliation, a critical component of successful hospital discharge. A workbook to help users implement the tool is included. http://www.ahrq.gov/qual/match/.

The AHRQ Innovations Exchange includes a repository of user-submitted experiences on implementing a quality improvement effort around unnecessary readmissions. The exchange includes lessons learned, tools, and user-developed resources. For details, go to: http://www.innovations.ahrq.gov/innovations_qualitytools.aspx?search=Readmissions.

AHRQ's PSNet (Patient Safety Network) offers a searchable compendium of resources and tools on hospital discharge and related topics, such as medication reconciliation. For more information, go to: http://www.psnet.ahrq.gov/collectionBrowse.aspx?taxonomyID=412.

Also available is a primer that explains how problems with the hospital discharge process can lead to adverse events or complications that result in patients returning unnecessarily to the hospital. To learn more, go to: http://psnet.ahrq.gov/primer.aspx?primerID=11.

The STAAR (STate Action on Avoidable Rehospitalizations) Initiative, supported by the Institute for Healthcare Improvement, is a multi-State effort to improve care transitions. For free resources go to: http://www.ihi.org/offerings/Initiatives/STAAR/Pages/default.aspx.

Current as of November 2012

Internet Citation:

Resources for Reducing Unnecessary Hospital Readmissions. Agency for Healthcare Research and Quality, Rockville, MD. http://www.pso.ahrq.gov/readmin/readminres.htm