29 Jan Not All Hospital Readmissions Are Preventable but READI Protocol Can Assist in Some Cases
MedicalResearch.com Interview with:
Marianne Weiss DNSc RN
READI study Principal Investigator
Professor of Nursing and
Wheaton Franciscan Healthcare / Sister Rosalie Klein Professor of Women’s Health
Marquette University College of Nursing
Milwaukee Wi, 53201-1881
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Our team of researchers has been studying the association of patient readiness for discharge and readmission for several years. We have previously documented that patients who had ‘low readiness’ on our Readiness for Hospital Discharge Scale were more likely to be readmitted. In this study we added structured protocols for discharge readiness assessment and nurse actions to usual discharge care practices to determine the optimal protocol configuration to achieve improved post-discharge utilization outcomes.
In our primary analysis that included patients from a broad range of patient diagnoses, we did not find a significant effect on readmission from adding any of the discharge readiness assessment protocols. The patient sample came from Magnet hospitals, known for high quality care, and the average all-cause readmission rates were low (11.3%).
In patients discharged from high-readmission units (>11.3%), one of the protocols was effective in reducing the likelihood of readmission. In this protocol, the nurse obtained the patients self-report of discharge readiness to inform the nurse’s discharge readiness assessment and actions in finalizing preparations for discharge. This patient-informed discharge readiness assessment protocol produced a nearly 2 percentage point reduction in readmissions. Not unexpectedly, in lower readmission settings, we did not see a reduction in readmission; not all readmissions are preventable.
In the last phase of study, we informed nurses of a cut-off score for ‘low readiness’ and added a prescription for nurse action only in cases of ‘low readiness’; this addition to the protocol added burden to the nurses’ daily work and eliminated the beneficial effects, perhaps because it limited the nurse’s attention to only a subset of patients.
MedicalResearch.com: What should readers take away from your report?
Response: The take home message is that in settings where readmissions are high, including the patient’s voice in evaluating their readiness to go home from the hospital can assist nurses in addressing issues and concerns that can result in returning to the hospital for readmission. The READI protocol is a low-cost / low-intensity supplement to the hospital’s existing discharge initiatives that nurses can easily incorporate into their day-of-discharge practices.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: We need to study further the effect of the READI protocol in low readmission hospitals. Discharge readiness assessment was added to existing discharge care practices. More investigation is needed about the relative value-added of each of the many recommended discharge preparation practices in order to determine the combination that most efficiently and effectively prepares patients for discharge. Our research has focused on the role of nurses in helping to reduce readmissions. We need to know more about how health care teams work together as partners to optimize discharge to reduce readmission risk.
MedicalResearch.com: Is there anything else you would like to add?
Response: Engaging patients in their care is a dual responsibility of healthcare professionals and patients. Patients and families should initiate conversations about discharge early to advocate for information and assistance in making a smooth and uneventful transition home after hospitalization.
The research team (Weiss, PI) was commissioned by the American Nurse Credentialing Center (ANCC) following a competitive application process. The study was funded through participation fees from study hospitals. The research team and the results, analysis, conclusions, and recommendations of the study are independent of ANCC and do not necessarily reflect the views of ANCC.
Weiss ME, Yakusheva O, Bobay KL, et al. Effect of Implementing Discharge Readiness Assessment in Adult Medical-Surgical Units on 30-Day Return to Hospital: The READI Randomized Clinical Trial. JAMA Netw Open. 2019;2(1):e187387. doi:10.1001/jamanetworkopen.2018.7387
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