Patients are staying fewer days in the hospital and receiving "post-op" and "post-hospital" care at home. The days of staying 10 days for an appendectomy, or hysterectomy, or pneumonia or joint replacement or just about anything are long gone. These shorter hospital stays require patients to really understand what will happen when they go home. Coordination about appropriate follow-up is essential, as well as medications, pending lab tests etc. In 2007 a study sponsored by the Agency for Healthcare Research and Quality (AHRQ) found that more than 1/3 of patients discharged from a large teaching hospital, failed to get follow up care. Yikes!!!
I was interested to read about a new program that is being piloted in Boston called Project RED (short for Re-engineered Discharge) and led by family medicine doctor Brian Jack. The program uses 11 steps to make sure patients are well cared for at discharge. I will try to give a brief description:
- Educate the patient about the diagnoses throughout the hospital stay
- Make follow up appointments and testing for the patient before they go home
- Discuss any tests or studies from the hospital and make sure there is someone responsible for follow-up
- Organize post discharge services, including making appointments and guaranteed transport
- Confirm the medication plan and make sure the patient understands
- Make sure the discharge plan goes with national guidelines
- Review steps to take if a problem arises..who to call, what is an emergency
- Ensure all physicians receive the discharge summary
- Ask the patients to explain the plan in their own words
- Give the patient a written discharge plan with medications listed
- Phone the patient 2-3 days after discharge to resolve problems
Why isn't everyone doing this? There are absolutely no financial incentives to implement a discharge program such as this. Hospitals are busy, chaotic places and protocols, training and accountability need to be put into place. The rapid admit/discharge pace and obscene amount of stupid charting that is "required" to be done, leaves little time for doing things that really help patient care.
As we talk about health care reform, we also need to institute re-engineered processes that put the patient first and reward caregivers who do it right.