Effect of Implementing Discharge Readiness Assessment in Adult Medical-Surgical Units on 30-Day Return to Hospital

Abstract

Key Points Question What is the effect of adding structured nurse assessment of patient readiness for discharge to standard medical-surgical unit discharge practices on 30-day return to hospital? Findings In this multisite cluster randomized clinical trial, when patient self-assessments were combined with readiness assessment by nurses, high-readmission units showed a reduction in 30-day hospital returns. Mixed results were observed for nurse assessments only and for low-readmission units. Meaning Adding a structured discharge readiness assessment by the discharging nurse that includes patient self-assessment to standard practice for hospital discharge may reduce readmissions and emergency department or observation visits.

Individual Nurse Productivity in Preparing Patients for Discharge Is Associated With Patient Likelihood of 30-Day Return to Hospital

“…The patient sample was representative of adult medical-surgical patients (59 y old, 51% female individuals). The average patient’s RHDS was close to 8.5, consistent with prior work in similar patient populations 19,22,23,27,28. Approximately 13% of patients were readmitted during the 30 days postdischarge (Table 1).…”

“…We conducted a secondary analysis of data collected for the READI (Readiness Evaluation And Discharge Interventions) study 19. The parent study was a multihospital cluster-randomized clinical trial to test the impact of unit-based implementation of a discharge readiness assessment intervention on readmission and ED use.…”

“…We used a large multihospital data set from a cluster-randomized clinical trial of a discharge readiness intervention19 to study the association of nurse productivity with patient outcomes. The study had 2 specific aims:To estimate and describe the discharge preparation productivities of individual nurses.…”

Ready to Go Home? Assessment of Shared Mental Models of the Patient and Discharging Team Regarding Readiness for Hospital Discharge

“…20 The RHDS/SF scales have undergone rigorous psychometric testing and are linked to patient outcomes (eg, readmissions, emergency room visits, patient coping difficulties after discharge, and patient-rated quality of preparation for posthospital care). 20,[25][26][27][28] For example, predictive validity assessments for adult medical-surgical patients found lower Nurse-RHDS/SF scores are associated with a six-to ninefold increase in 30-day readmission risk. 20…”

Patterns of patient coping following hospital discharge from medical and surgical units: A pilot study

“…Based on the relatively weak correlations observed between scores for readiness for discharge and the measures of experienced coping, the predictive ability of patients' expectations of postdischarge coping may be limited. However as noted by Weiss et al (2019), even if patient ratings of discharge readiness are not predictive of transition problems, the tool is useful as a patient-centered measure of the hospitalization phase of care. The need for more metrics capturing the quality of the clinical experience for patients and their families in terms of their perceptions of aspects of care, such as symptom management and communications supporting care transitions, has been recognized (Galvin et al, 2017;Nagle, 2018).…”