Developing an ED Discharge Team to Incorporate the Re-Engineered Discharge (RED) Toolkit in a Rural Emergency Department

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Krause, Adriane
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Research Subject Categories::INTERDISCIPLINARY RESEARCH AREAS::Caring sciences::Nursing , Quality Improvement , Electronic Health Records , Patient Readmission , Patient Discharge , Emergency Service, Hospital
Background: The 72-hour return rate represents an important quality indicator and benchmark for Emergency Department (ED) care to determine if high quality and safe care is being delivered at a particular facility. The RED toolkit was created by Boston Medical University to aide in improving the discharge process and reducing hospital readmission rates and ED return rates (Adams et al, 2014). This quality improvement project utilized the RED components 2 and 11 from the RED toolkit and the project is referred to as Project Red. Component 2 is aimed at securing post-discharge follow-up appointments and Component 11 is aimed at transmission of discharge summaries to the PCP seen for follow-up. Objective: The primary goal of this quality improvement (QI) project was to establish an ED discharge team in order to improve the discharge process for patients meeting Emergency Severity Index (ESI) Level 3 criteria. The secondary outcome measure of this QI project was to preschedule post-discharge follow-up appointments with the PCP within the recommended time frame in an effort to reduce the 72-hour return rate. Methods: While the goal of this project was reduction in 72-hour return rates, the target population was the ED nursing staff and the ED administrative personnel. Patients meeting the project criteria were tracked by the principal investigator (PI) through the electronic medical record (EMR) with a concurrent log of staff compliance with the Project Red guidelines regarding recommended time frame of follow-up and if the appointment with the PCP was completed. Comparison of pre- and post-implementation of 72-hour return rates were measured. Results: Analysis of utilization of the Project Red guidelines showed 80.95% of patients received an appointment to follow-up with a PCP within the recommended time frame. Project RED had a positive effect on the 72-hour return rate. While 19 participants were identified and participated in Project RED, 82 patients were found to meet qualifications but were not identified by the ED staff resulting in a 7.3% 72-hour return rate for those 82 patients, while the 19 who were identified had a zero percent 72-hour return rate. Conclusion: The target population of the QI project was the ED nursing staff and the ED administrative personnel. The project had 95% participation of the nursing staff and 100% participation of the administrative personnel. This QI project proved to have a positive impact on the follow-up of patients with an ESI Level 3 classification. The secondary outcome of decreasing the 72-hour return rate was met as none of the Project RED participants returned and 7.3% of the patients who qualified but did not participate returned during the intervention period. Keywords: 72- hour return rate, emergency department, quality improvement, RED Toolkit