Adams Carol J, Stephens Kimberly, Whiteman Kimberly, Kersteen Hal, Katruska Jeanne
Waynesburg University, Waynesburg, Pennsylvania (Drs Adams, Stephens, and Whiteman, and Mr Kersteen); and Southwest Regional Medical Center, Waynesburg, Pennsylvania (Ms Katruska).
Qual Manag Health Care. 2014 Jul-Sep;23(3):169-77. doi: 10.1097/QMH.0000000000000032.
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.
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.
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.
全国医院再入院率平均为19%。每年每5名医疗保险患者中就有1人在出院后30天内再次入院，导致额外费用达175亿美元。
目标/目的：本质量改进项目的目的是采用联合委员会资源-医院参与网络和重新设计出院流程项目（RED项目）概述的方法，重新设计出院流程，降低医院30天全因再入院率，并提高患者/家属在出院流程中的参与度。
使用联合委员会资源-医院参与网络的方法以及医疗保健研究与质量机构RED项目工具包、出院后护理计划和患者出院调查问卷，将最佳出院实践纳入患者护理并评估项目结果。在4个月的时间里，对一家农村社区医院一个拥有30张床位的专门内科-外科病房出院的336名患者的每月再入院率以及患者/家属在出院流程中的参与度进行了检查。
在为期4个月的项目期间，再入院率降低了32%（降至7.12%）；与基线相比，每月总体降幅为27%，在前6个月中与基线相比降幅为44%。患者和家属对出院流程的看法是积极的。
