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Implementation of the Re-Engineered Discharge (RED) Toolkit to Decrease All-Cause Readmission Rates at a Rural Community Hospital

Adams, Carol J. DNP, BSM, RN; Stephens, Kimberly DNP, RN; Whiteman, Kimberly DNP, RN; Kersteen, Hal MBA; Katruska, Jeanne BSN, RN

doi: 10.1097/QMH.0000000000000032
Original Articles

Overview: National hospital readmission rates average 19%. One in 5 Medicare patients are readmitted within 30 days of discharge each year, resulting in $17.5 billion in additional costs.

Objective/Purpose: The aim of this quality improvement project was to use the methodology outlined by Joint Commission Resources-Hospital Engagement Network and Project Re-Engineered Discharge (Project RED) to redesign the discharge process, reduce hospital 30-day all-cause readmission rates, and improve patient/family involvement in the discharge process.

Method: The methodology of the Joint Commission Resources-Hospital Engagement Network and the Agency for Healthcare Research and Quality Project RED toolkit, the After Hospital Care Plan, and a patient discharge questionnaire were used to incorporate best discharge practices into patient care and evaluate the outcomes of the project. Monthly readmission rates and patient/family involvement in the discharge process were examined for 336 patients discharged from a dedicated 30-bed medical-surgical unit in a rural community hospital over a 4-month period.

Results: During the 4-month project, readmissions were reduced by 32% (rate 7.12); the overall monthly reduction from baseline was 27%, with a 44% reduction from baseline during the previous 6 months. The patient and family perception of their discharge process was positive.

Waynesburg University, Waynesburg, Pennsylvania (Drs Adams, Stephens, and Whiteman, and Mr Kersteen); and Southwest Regional Medical Center, Waynesburg, Pennsylvania (Ms Katruska).

Correspondence: Carol J. Adams, DNP, BSM, RN, Waynesburg University, 272 Preston St, Pittsburgh, PA 15205 (

The authors thank the executive management, hospitalists, pharmacists, readmissions team, case management, and unit nurses at Southwest Regional Medical Center for their valuable role in this article. The authors also thank Joint Commission Resources-Hospital Engagement Network consultants for their guidance.

The authors report having no conflicts of interest related to this article.

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