READI Study Background

Reducing readmission and ED utilization rates is central to health care improvement and reform efforts (Naylor et al, 2011). Recent research has linked hospital nurse staffing to readmission rates (McHugh et al., 2013; Weiss et al., 2011). With Medicare readmission rates approaching 20% (Jencks et al., 2009) and financial penalties for high rates of 30 day readmission, novel approaches to engaging hospital nurses in readmission reduction efforts hold significant promise for promoting high-quality affordable patient care.

Problems with hospital discharge are well documented. Perceived inadequacies in discharge planning, teaching, and coordination are associated with greater likelihood of postdischarge problems, ED use, and readmission (Banja et al., 2007; Bull et al., 2000; Coleman et al., 2005; Henderson & Zernicki, 2001; Jack et al, 2009). Most readmissions within 30 days are viewed as preventable (Medpac, 2007) and failures of discharge preparation (Minott, 2008).

Large scale initiatives to improve discharge transitions have focused on communication and coordination of care between hospital and community providers using specialized roles for transition support (Coleman et al., 2006; Jack et al., 2009; Naylor et al., 1999, 2004, Nielsen et al., 2008). The role of the acute care staff nurse has been virtually ignored in discharge transition initiatives, despite the fact that, in most hospitals, the staff nurse is responsible for the complex processes of preparing patients for discharge (Foust, 2007; Nosbusch, Weiss, & Bobay, 2011).

Readiness for discharge is an outcome of discharge preparation. In previous research by this study team, the 21-item Readiness for Hospital Discharge Scale (RHDS) has been developed and tested with multiple inpatient groups (Weiss et al., 2006, 2007, 2008, 2009; Lerret & Weiss, 2011). In measuring readiness for discharge to home following adult medical-surgical hospitalization, patient self-report [PT-RHDS] and nurse assessment [RN-RHDS] forms of the scale have demonstrated an association with post-discharge utilization (readmissions and ED visits) (Weiss et al., 2007, 2010, 2011). The RHDS was reduced to an 8-item version for use in clinical practice. The 8-item RN-RHDS was more strongly associated with readmission than the 8-item PT-RHDS in 2 adult samples in the Midwest and Eastern US (Weiss et al., 2010; Weiss et al, in review). Patients with low readiness by nurse assessment experienced more than a 6-fold increase in the likelihood of being readmitted (Weiss et al., in review).

Currently there is no standard approach or tool available for routine use in clinical practice. The body of evidence from prior studies by the research team lays the foundation for the recommendation that pre-discharge readiness assessment be implemented as a standard nursing practice (Weiss et al., 2011).

Previous Studies by the READI Study Team