Starting a robust discharge planning program – or strengthening an existing one – can produce benefits far beyond a smooth and seamless transition for a patient. Top-flight discharge planning can boost a patient’s adherence and preparedness, streamline follow-up care and
reduce costly readmissions, saving hospitals and facilities large sums of money.
Federal laws mandate that hospitals have a discharge planning program in place, but they don’t stipulate which kind of process a facility must have. In light of the
upcoming penalties for poor readmission rates, the case for a thorough discharge planning program speaks for itself. Consider this: Project RED, an initiative at Boston Medical Center that uses an 11-step process to optimize discharge planning, saw a 30 percent decrease in rehospitalizations and a 33 percent drop in ED use among patients in the RED program (RED stands for Re-Engineered Discharge).
"National statistics have shown that most errors occur during transitions in care from one care setting to another," says Robin Jones, RN, quality improvement coordinator at Valley Baptist Medical Center and faculty member of the upcoming Case In Point Webinar,
Securing Care Transitions to Prevent Avoidable Readmissions. "Without appropriate preparation and coordination, necessary information, testing, and services fall through the cracks causing an additional strain on patients, families and resources."
The same study produced a savings of $412 per patient (and that’s before factoring in the
penalties for readmissions coming in 2012). According to Jones, the fiscal benefits are just the beginning. "Focusing on better discharge planning and education has improved our patient and downstream provider satisfaction, HCAHPS, core measures, medication reconciliation, medication errors, adverse drug events, patient education/literacy awareness, hospital flow/throughput, length of stay, patient safety and readmissions," says Jones, whose organization is one of the 14 chosen to work with the Centers for Medicare and Medicaid's
Community-Based Care Transitions Program, which is offering $500 million of grants to organizations seeking to improve their transitions of care.
The question is, how can one get started on a brand new – or revised – discharge planning program?
Like any far-sighted strategy, discharge planning brings together a solid action plan with measured steps that ensure the plan’s success. Consider the following seven-step action plan for a comprehensive, outcomes-improving, cost-cutting discharge planning program.
- Structure Staff Responsibilities. The action plan starts with a clear vision of the program for both the managing staff and the frontline employees. Without a clear picture of their new roles and responsibilities, staff will inevitably fail to step into their roles with 100 percent buy-in, creating a disjointed process from the get-go.
- Tailor the Program to your Facility. Project RED, for one, has 11 components that range from early intervention measures to telephonic follow-up after discharge. (What are the 11 components of Project RED? View them now.) All of these components may or may not be suitable for your facility at a given time. Pick and choose the right components for your organization’s structure, and remember that every evidence-based step is a step in the right direction.
- Make Sure Patients Understand. The steps you are going to incorporate into your overall strategy will be far less effective if your patients aren’t able to adhere to instructions – and that means paying close attention to health literacy. The materials and information surrounding the discharge plan, including educational materials and post-discharge instructions, should be easy to comprehend. The better the comprehension, the more likely the outcomes will be as you want them.
- Mold the Timeline. In order to provide patients with the information that will boost their transitions, including education about their condition and instructions for their post-discharge care, the intervening professional may need to spend more time with the patient than usual. This means the workflow will have to be adapted to fit this new endeavor.
- Choose Convenient Follow Up. To guarantee adherence to the plan, the follow-up care must be convenient – for the patient, that is. If the follow-up appointments are at a time when the patient will have a difficult time coming in, chances are that the patient will falter in the plan of care. It is important to verify that the patient can make the follow-up plans.
- Make Case Managers Available. Many case managers work a shift from early morning to mid-afternoon, a timeframe that may not be the most in sync with patients who are discharged and the staff discharging them. Facilities may want to consider extending case manager access so that the coordination effort is more aligned.
- Check the Checklist. A written (or printed) checklist of all discharge planning-related responsibilities will help guarantee that the right steps are in place for all patients leaving the facility.
Following these seven steps will put you on the path to a new and improved discharge planning process. Your quality measures, not to mention your organizational leadership, will thank you.
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