¾ In  the  United  States  one  in  five  Medicare  patients   discharged  from  the  hospital  experience  an   adverse  event  within  three  weeks
¾ Nationally,  75%  of  hospitals  receive  monetary   penalties  for  readmissions
¾ There  is  a  perception  that  the  current  discharge   process  at  Hahnemann  Hospital  is  inefficient  and   does  not  follow  a  validated  process
¾ Project  RED  (Re-­‐‑Engineered  Discharge)  is  a   discharge  checklist  developed  at  Boston
University  Medical  Center  shown  to  reduce   adverse  events  associated  with  the  discharge   process
¾ Created  by    Brian  Jack,  M.D.  at  Boston  University
Medical  Center.    Dr.  Jack  created  Project  RED  (Re-­‐‑
Engineered  Discharge).  Through  his  work,  he   implemented  the  following  checklist:
9 Reconcile  medications
9 Reconcile  discharge  plan  with  national  guidelines
9 Make  follow-­‐‑up  appointments
9 Follow  up  on  outstanding  tests
9 Arrange  post-­‐‑discharge  services
9 Create  a  written  discharge  plan
9 Inform  patient  what  to  do  if  problem  arises
9 Educate  patient
9 Assess  patient  understanding
9 Send  discharge  summary  to  primary  care   physician
9 Reinforce  the  discharge  plan  via  telephone
¾ Dr.  Jack  was  able  to  decrease  hospital   readmissions  by  30%  with  this  system.
¾ Using  an  exploratory  sequential  mixed  methods   design
¾ Drexel  Family  Medicine  residents  (18)  and
Attending  Physicians  (7)  were  surveyed  regarding   the  current  discharge  process  at  Hahnemann
Hospital
¾ Based  on  the  results,  we  plan  to  create  and   implement  a  validated  discharge  template  aimed   at  improving  efficiency  and  efficacy  of  the   discharge  process.
¾ The  majority  of  interns  report  they  spend  up  to
30  minutes  on  the  discharge  process  and  72%  of   all  residents  feel  that  the  current  discharge   summary  does  not  meet  the  goals  set  by  Project
RED  (Figure1).
¾ 72%  of  residents  and  100%  of  Attending
Physicians  believe  incorporating  the  discharge   template  will  facilitate  dictations  and  100%
(Figure  2)
¾ The  majority  of  residents  cited  that  the  current   discharge  summary  is  redundant,  disorganized   and  incomplete  (Figure  3)
¾ The  majority  of  Attending  Physicians  felt  it  is   inefficient  and  incomplete  (Figure  3)
¾ 100%  of  Resident  and  100%  of  Attending
Physicians  feel  that  incorporating  a  validated   checklist  will  improve  patient  care  (Table  1)
Percentage  of  residents  and  Attending
Physicians  that  feel  the  current  discharge  summary   meets  the  goals  of  Project  RED.
Percentage  of  residents  and  Attending
Physicians  that  believe  implementing    a  standardized   check  list  will  facilitate  dictations.
¾ Family  medicine  residents  and  attending   physicians  are  not  satisfied  with  our  current   discharge  process.
¾ Based  on  this  information,  we  believe  it  is   appropriate  to  change  the  discharge   summary  by  incorporating  a  standardized   discharge  template  based  on  the  validated
Project  RED  checklist.
¾ Future  QI  projects  will  determine  if   implementing  this  template  will  create  more   consistent  transitions  of  care,  decrease   adverse  events  and  readmissions  and   improve  patient  care.
¾ Following  a  validated  discharge  process  is   likely  to  improve  communication  between   inpatient  services  and  primary  care   providers.
¾ This  will  allow  for  more  accurate  and  timely   communication  that  is  essential  in  the   medical  field  for  preventing  readmissions   and  adverse  events  associated  with  the   hospital  discharge  process.
¾ Our  aim  is  to  quantify  the  perception  of  the  family   medicine  department  regarding  the  current   discharge  process  to  determine  if  implementing  a   validated  discharge  template  is  warranted.
PGY1 (n = 7)
Percentage Yes Percentage No
100% 0%
PGY2 (n = 5) 100%
100%
0%
0% PGY3 (n = 6)
Attending Physicians
(n = 7)
100% 0%
Percentage  of  Residents  and  Attending
Physicians  that  believe  implementing  the  checklist   will  improve  patient  care.
Top  complaints  from  residents  and  Attending
Physicians  regarding  the  current  discharge  summary.
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October  12,  2014.   http://www.kaiserhealthnews.org/Stories/2014/October/02/Medicare-­‐‑readmissions-­‐‑penalties-­‐‑
2015.aspx