To prevent rehospitalizations from nursing homes, discharge process is key, MU researchers find

February 14th, 2019

COLUMBIA, Mo. – Hospitals have made great strides in improving their discharge processes, which, when done well, prevent rehospitalizations and save Medicare and Medicaid significant costs each year. The discharge process from nursing homes to home is equally complex and often involves the elderly and those with long term chronic health conditions. Attempts to improve this process, however, have largely focused on hospitals.

Now, for the first time, researchers at the University of Missouri have adapted a discharge process used in hospitals to fit the unique needs of short stay nursing home patients. This process, known as Reengineered Discharge (RED), has been found to significantly reduce rehospitalizations when used in hospitals and in hospital-based “Skilled Nursing Facilities.”

“We wanted to see if we could take this hospital-based discharge process and adapt it to free-standing community nursing homes,” said Lori Popejoy, associate professor at MU’s Sinclair School of Nursing. “The hope is that when patients are discharged from nursing homes, they are not readmitted either to the nursing home or the hospital.”

The RED process focuses on preparing patients for the challenges and responsibilities they will face once discharged. This includes arranging follow-up appointments, reconciling medications, and communicating discharge information to the patient’s primary care provider. Popejoy and her colleagues systematically adapted this hospital-based process to nursing homes by identifying critical differences between nursing home discharges and those at hospitals. For example, it is vital that nursing homes include the resident’s family in the discharge process, as family members are often responsible for giving medication and other forms of care at home.

Researchers also sought to bridge a disconnect between primary care providers and their patients, as the care providers are often unaware that their patients have been admitted to a nursing home. While some hospitals have more integrated computer systems that tell providers when their patients have been hospitalized and provide access to discharge records, this type of process does not typically exist in nursing homes. To address this challenge, one of the four nursing homes in this study developed a communication tool that allowed for more comprehensive communication with primary care providers. This tool inspired others to overhaul their discharge records and provide more complete reports to providers.

“The facilities where we tested this process thought they were doing okay before, but RED revealed a lot of areas that needed improvement,” Popejoy said. “Nursing homes have unique needs and challenges that need to be considered when creating a better discharge system. For instance, the facilities we worked with lacked fail safes for ensuring patients received proper medications. Being confronted with those challenges helped the facilities come up with innovative solutions and gave them a better idea of how to meet their obligations to their patients for a safe and effective discharge.”

The study, “Adapting project RED to skilled nursing facilities,” was published in Clinical Nursing Research. Other researchers who contributed to the study were Amy Vogelsmeier, Bonnie Wakefield, Alexandria Lewis and David Mehr of the University of Missouri; Colleen Galambos of the Helen Bader School of Social Work; and Diane Huneke of the Family Health Center. Funding was provided by the Agency for Health Care Research and Quality (R24HS022140). The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies.