Rethinking patient discharge to reduce nursing home rehospitalizations

February 18, 2021
by Robin Lasky, Contributing Reporter
Implementation of the Re-Engineered Discharge program (Project RED), was found to reduce rehospitalization rates for nursing home patients following discharge in a recent study from the University of Missouri Sinclair School of Nursing.

Since 2007 the Project RED program has been used by hospitals across the U.S. to improve levels of satisfaction, outcomes, and reduce rehospitalization rates for patients following discharge. The program brings together various post-discharge strategies for achieving these goals, such as continued post-discharge contact with patients and assistance in coordinating medications and ongoing appropriate post-discharge care, for systemized deployment by hospitals.

The authors of the UM study observed an overemphasis on gauging the satisfaction of discharged nursing home patients via phone surveys, and aimed to determine the effect the method of deploying Project RED in nursing homes has on improving results for discharged patients.

“Follow up phone calls have traditionally revolved around patient satisfaction, but we have found the more important question is finding out if the discharge plan is being implemented as it was designed,” said lead author Lori Popejoy in a statement. “Ensuring that appointments are scheduled, services have started, and medications are correct and available will help ensure the discharge process goes as smoothly as possible, ultimately resulting in improved patient care and better health outcomes.”

During the COVID-19 pandemic, hospitals have had to find ways to rapidly adjust to finding new strategies to cope with scarce resources in order to continue to provide quality care. The overall strain on hospital resources has incentivized earlier discharge, and otherwise prompted a greater percentage of patients relying on expanded availability of telehealth and other remote healthcare options from home, as well as delays in receiving other less urgent care. This new environment further underscores a need for more study and emphasis on reliability and continuation of care following discharge, particularly among nursing home patients, one of the groups hit hardest by the pandemic.

For this study, the UM team of researchers focused on the effects of implementation of Project RED following training conducted in a one-day workshop, versus implementation following training carried out, and reemphasized, over a period of several months. The study concluded that the rate of rehospitalization was 45 to 50 percent higher among patients of the hospitals that only had the benefit of the one-day training workshop, highlighting a need for more consistent emphasis and education of nursing home staff in their involvement in post-discharge care.

A review of data by the WSJ last December, indicated that though nursing home patients represent only 2% of the population, they account for more than one-third of COVID-19 deaths.