January 25, 2019
MILWAUKEE – A team of researchers led by Principal Investigator Dr. Marianne Weiss, RN, professor of nursing at Marquette University, recently conducted a randomized clinical trial (the READI study – Readiness Evaluation and Discharge Interventions) to test whether nurses can reduce patient readmissions and emergency departments visits after discharge by adding a structured assessment of patient discharge readiness prior to discharge. The study was published in the Journal of the American Medical Association (JAMA) Network Open on Jan. 25, 2019.
“Reducing readmissions and emergency department visits is a national priority that has led to numerous initiatives to improve the health care experience, patient outcomes and cost of health services. Despite these efforts, readmission rates remain high in some hospitals,” said Dr. Weiss. “In high readmission settings, we found that adding tools for nurses to evaluate patient readiness for discharge helped to reduce readmissions in the first 30 days after hospital discharge.”
The research team included nurse and economist researchers from the University of Michigan; Loyola University Chicago; University of Maryland, Baltimore; University of South Carolina; Abt Associates and St. Ambrose University. The study was conducted from 2014 to 2017 and included more than 144,000 adult patients from 66 patient care units in 33 Magnet-designated hospitals.
The discharge readiness assessment tools used in the READI study are a low-intensity, low-cost approach to improving the quality of hospital discharge. The short eight-item questionnaire for both nurse assessment and patient self-assessment produces actionable information to identify areas of low readiness for discharge and to help prepare patients for discharge. The questionnaires capture four dimensions of readiness: personal status (physical readiness and energy); knowledge (problems to watch for and restrictions); perceived coping ability (handling demands at home and performing personal care); and expected support (help with personal care and help with medical care). Most nurses completed the nurse questionnaire in under two minutes and most patients completed the patient questionnaire in under five minutes.
The study found that readmission rates were reduced by up to 1.79 percentage points when nurses conducted discharge readiness assessments on the day of discharge in a format that included direct input from the patient. The effectiveness was evident for hospital units with higher readmission rates – greater than 11 percent.
“Incorporating the patient’s perspective in the assessment of discharge readiness was a key feature of the new pre-discharge assessment process. This allowed the nurses to plan more effectively for patients’ discharge needs,” explained Dr. Weiss.
The study concluded that hospitals should consider incorporating the READI assessment tools into hospital discharge practices for patients going home as a strategy to reduce high rates of readmission.
“We recommend discharge readiness assessment as a standard practice for hospital discharge because it brings the patient’s voice into planning and decisions about discharge. It also supplements existing hospital efforts to help patients avoid problems post-discharge than can result in a return to the hospital,” concluded Dr. Weiss.
Lynn is chief marketing and communication officer. Contact Lynn at (414) 288-4719 or lynn.griffith@marquette.edu.
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