READI – Readiness Evaluation
and Discharge Interventions Study
Study Introduction and Phase 1 Training
Description:
This course is designed to explain the READI ( Readiness Evaluation
and Discharge Interventions Study). It will take approximately 20
minutes to complete this course.
Learning Objectives
The audience for this training includes RNs who will
care for patients being discharged to home.
After completing the training, you will be able to:
• Describe the design and procedures for the READI
study
• List the process steps for completing the Nurse
version of the Readiness for Hospital Discharge
Scale in Phase 1 of the READI study.
READI Study
READI:
Readiness Evaluation And Discharge Interventions
Multi-site study, commissioned by the American Nurses
Credentialing Center
ANCC goals:
1. Leverage the power of Magnet Hospitals to engage in large
scale research on topics of importance to nursing practice.
2. Engage clinical nurses in research about their practice
3. Create learning opportunities about nursing research in
clinical practice settings.
32 Participating Magnet Hospitals
READI STUDY TEAM
MARQUETTE UNIVERSITY
Marianne Weiss, DNSc, RN,
READI PI
UNIVERSITY OF MARYLAND
Linda Costa, PhD, RN, NEA-BC
Kathleen Bobay, PhD, RN, NEA-BC
UNIVERSITY OF MICHIGAN
Olga Yakusheva, PhD
Ronda Hughes, PhD, RN, FAAN
READI STUDY AIMS
Translating prior research findings into practice
Research Question:
What is the impact on patient outcomes, including costs, when
nurses assess for discharge readiness as a standard practice?
Statement of Purpose:
To determine the impact on post-discharge utilization
(readmissions and ED visits) and costs of implementing
discharge readiness assessment as a standard nursing practice
for adult medical-surgical patients.
Why study discharge readiness
and readmission
• National focus on discharge transitions and readmission.
• Discharge preparation is a primary function of hospitalbased nursing.
• Discharge readiness is an important outcome of
hospitalization.
• Inadequacies in discharge preparation are well
documented and have been associated with ED visits
and readmissions.
Prior studies about discharge
readiness assessment
• Nurse assessment of discharge readiness is
associated with risk of readmission within 30 days
post-discharge.
• 10-15% of patients are assessed as having low
readiness on the day of discharge.
• Patients with low readiness on nurse assessment are
6 – 9 times more likely to be readmitted within 30
days.
Weiss, Yakusheva, & Bobay, 2010
Weiss, Yakusheva, Costa, & Bobay, 2014
From observational studies to
implementation
What we know and don’t yet
• We know, from observational, non-implementation
know
studies, that discharge readiness is associated with
risk of adverse post-discharge outcomes including
readmission
• We don’t yet know if implementing discharge
readiness assessment as a standard nursing practice
on the day of discharge can result in improved
discharge transition care leading to improved
outcomes, specifically fewer readmissions and ED
visits.
The study investigates the contribution of clinical nursing
practice to post-discharge outcomes.
READI Study Design
Randomized implementation at the nursing unit level
• random assignment of implementation and control units in each
hospital
Implementation unit: uses Discharge Readiness tool with every
patient discharge to home
Control unit: Usual discharge care processes
4 phases – 4 months each
• Baseline – current state
• Phase 1 – implementation of discharge readiness assessment tool
• Phases 2 & 3 will be announced after Phase 1 – variations on
Phase 1 protocol to determine optimal implementation approach
Study Design
Stepped sequential implementation:
Steps Baseline
4 months
Study Units
Phase 1
4 months
Phase 2
4 months
Phase 3
4 months
Implementation Baseline Discharge
Readiness
Assessment
protocol using
RN-RHDS
Modifications to Modifications to
the Discharge the Discharge
Readiness
Readiness
Assessment
Assessment
protocol
protocol
Control
Concurrent
control
Baseline Concurrent
control
control
Concurrent
control
Multi-level Design Framework
Donabedian’s Quality
Model
Study Variables
Unit level
Structure
Context variation
Discharge Model of Care
Nurse Staffing
Patient Level
Nursing Process
Discharge Readiness Assessment
Patient Outcomes
Readmissions
ED visits post-discharge
Sample
• 2 medical/surgical type units per hospital
• Implementation unit
• Control unit
• Sample is all patients and their discharging nurses
• Sample eligibility: 18+years, discharged to home.
• Total sample: All patients discharged home during
the study period. The number will depend on the
size of your unit.
• Total sample estimated to be 20,000
Tool for
Discharge Readiness Assessment
Readiness for
Hospital Discharge
Scale – Short Form
RN-RHDS
(Weiss et al., 2010, 2014)
8 questions
0-10 point scale
Higher scores = greater readiness
Completed by the discharging nurse on
the day of discharge (within 4 hours
before discharge)
Assessment should be used by the
nurse in conjunction with all other
nursing assessments to determine
individualized nursing interventions as
needed.
RNRHDS takes about 5 minutes to
complete
Other Research Data
All other data for the study will be electronically extracted by
Information Technology services at your hospital
• Outcome measures
 Readmission and ED use within 30 days postdischarge
• Patient and Hospitalization characteristics
 Demographic data
 Diagnoses
 Length of stay
 ICU admissions
• Nurse staffing data
 Unit level data on hours-per-patient-day, nurse
education, nurse experience.
READI Study – Phase 1
Hypothesis 1: Patients
discharged using the RN-RHDS
protocol will have fewer
readmissions and ED visits
when compared to patients
discharged under usual care
conditions.
READI Study:
Clinical Nurse Role
• Complete a discharge readiness assessment using the
RN-RHDS for every patient discharged to home.
• Use information obtained from the RN-RHDS in
planning discharge care needs.
• The RN-RHDS can be used to identify where patients
may have difficulty after discharge.
RN-RHDS:
8 Questions in 4 Subscales
Patient’s Personal Status
How physically ready
is your patient to go
home?
How would you
describe your patient’s
energy today?
Consider pain/discomfort, strength, emotional
readiness, physical ability to care for self
RHDS Subscales
Patient’s Knowledge
How much does your
patient know about
problems to watch for
after going home?
How much does your
patient know about
restrictions (what he/she is
allowed and not allowed to
do) after going home?
Consider caring for self at home, taking care of personal or
medical needs, who/when to call for problems, what happens
next in follow-up treatment plan, available community services
RHDS Subscales
Patient’s Coping Ability
How well will your
patient be able to
handle the demands
of life at home ?
How well will your patient
be able to perform his/her
personal care ( for
example, hygiene,
bathing, toileting, eating)
at home?
Consider ability to perform his/her medical treatments
RHDS Subscales
Patient’s Expected Support
How much help will
your patient have with
personal care after he/
she goes home?
How much help will
your patient have with
medical care needs
(medications,
treatments) at home?
Consider emotional support, help with household activities
Instructions for
Completing the RN-RHDS
Who
When
• All patients discharged to home
• Includes patients going to family homes or
independent living communities
• The RN-RHDS should normally be completed
within 4 hours before discharge.
• Usually completed after the majority of
discharge teaching has been completed.
• Allow time to respond to any concerns
identified in the RN-RHDS. Use your nursing
judgment to determine appropriate
interventions
Instructions for Completing the
RN-RHDS (Paper version)
Place patient label on the bottom of the
RN-RHDS form
Fill in RN Research ID
Answer the 8 RN-RHDS questions and the 5
additional patient descriptor questions.
Place completed forms in the designated
location on your unit for the READI
STUDY forms
Human Subjects Protection
• Approved through Marquette University IRB and your hospital
IRB
• Data will be reported only in aggregate form
• The researchers will not be able to identify specific patients or
nurses.
• We use the RN Research ID only for statistical purposes (to
adjust for a nurse taking care of multiple patients in the
study).
• All patient-level data will be de-identified by your site PI before
it is released to the research team.
Privacy
• Patient Labels will be removed before sending
to the study team
Patient
• Label information is needed by your site
Principal Investigator to request readmission
and patient descriptors from EHR
• The study team will not be able to link Nurse
IDs to a specific nurse.
Nurse
• No information will be provided to your
hospital administration regarding specific
nurses or their individual discharge readiness
assessments
Summary of roles in the
READI Study
Clinical Nurses
Site Principal
Investigator
CNO
Research
Team
• Complete the RN-RHDS
• Lead site efforts including staff
education
• Participate in advisory group
• Coordinate all aspects of the study
• Be available to sites for ongoing
communication
• Report back study findings to nursing staff
READI Study
Celebrating nursing’s contribution to the
discharge process and post-discharge outcomes
LAUNCH DATE:
___ (DATE) for training
___(DATE) for starting Discharge Readiness
Assessments
Questions?
1. Do you have questions about Phase 1?
Ask your site Principal Investigator or the educator conducting the
study training.
2. What will happen in phase 2.
You will complete a short training on revisions to the Phase 1
procedures 2 weeks before the start of Phase 2…. 4 months from now.
Discharge Readiness Assessment for every patient discharged home.
Thank you for your participation in this important
nursing research project.
References
Bobay, K., Jerofke, T, Weiss, M., & Yakusheva, O. (2010). Age-related differences in
perception of quality of discharge teaching and readiness for hospital discharge.
Geriatric Nursing, 31(3), 178-187.
Weiss, M.E. & Piacentine, L.B. (2006). Psychometric properties of the Readiness for
Hospital Discharge Scale. Journal of Nursing Measurement, 14(3), 163-180.
Weiss, M.E.,Piacentine, L.B., Lokken, L., Ancona, J., Archer, J., Gresser, S., . . . VegaStromberg, T. (2007). Perceived readiness for hospital discharge in adult medicalsurgical patients. Clinical Nurse Specialist, 21, 31-42.
Weiss, M. E., Yakusheva, O., & Bobay, K. L. (2010). Nurse and patient perceptions of
discharge readiness in relation to postdischarge utilization. Medical Care. 48(5):482-486.
Weiss, M., Yakusheva, O., & Bobay, K. (2011). Nursing staffing, readiness for hospital
discharge, and post-discharge utilization. Health Services Research, 46(5), 1473-1494.
Weiss, M.E., Costa, L., Yakusheva, O., & Bobay. K. (2013). Validation of patient and nurse
short forms of the Readiness for Hospital Discharge Scale and their relationship to return
to the hospital. Health Services Research, 49(1), 304-317.