READI (Readiness Evaluation And Discharge Interventions) Study
- Conditions
- Discharge Transition of Patients Discharged to Home
- Interventions
- Other: RN-RHDS protocolOther: RN-RHDS+PT-RHDS protocolOther: RN-RHDS + PT-RHDS + NIAF
- Registration Number
- NCT01873118
- Lead Sponsor
- Marquette University
- Brief Summary
Preparation of patients for discharge is a primary function of hospital-based nursing care and readiness for discharge is an important outcome of hospital care. Inadequacies in discharge preparation have been well-documented and linked to difficulty with self-management after hospital discharge and with increased likelihood of emergency department (ED) use and readmission. Prior studies by the research team have led to recommendations for implementation of discharge readiness assessment as a standard nursing practice for hospital discharge.
The investigators will conduct a multi-site study to determine the impact on post-discharge utilization (readmission and ED visits) and costs of implementing discharge readiness assessment as a standard nursing practice for adult medical-surgical patients discharged to home. The study tests, in a stepped approach, the impact of implementing discharge readiness assessment by the discharging nurse as standard nursing practice (RN-RHDS protocol), the incremental value of informing the nurse assessment with the patient's perspective (RN-RHDS+PT-RHDS protocol), and of requiring that the nurse initiates and documents risk-mitigating actions for patients with low readiness scores (RN-RHDS+PT-RHDS+NIAF protocol).
HYPOTHESIS 1: Patients discharged using the RN-RHDS protocol will have fewer hospital readmissions and ED visits within 30 days post-discharge compared to patients discharged under usual care conditions.
HYPOTHESIS 2: Patients discharged using the RN-RHDS+PT-RHDS protocol will have fewer hospital readmissions and ED visits within 30 days post-discharge compared to patients discharged using the RN-RHDS protocol.
HYPOTHESIS 3: Patients discharged by nurses using the RN-RHDS+PT-RHDS protocol plus a Nurse-Initiated Action Form \[NIAF\] (RN-RHDS+PT-RHDS+NIAF protocol) will have fewer post-discharge readmissions and ED visits than patients discharged using the RN-RHDS+PT-RHDS protocol; the effect will be strongest for patients with low RHDS scores.
Aim 4: Conduct cost-benefit analysis of implementing discharge readiness assessment as standard practice, by comparing cost-savings from reduced post-discharge utilization against implementation costs.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 189796
- Medical, surgical, or medical-surgical nursing units of Magnet designated hospitals
- Patients 18 years of age or more, English speaking,able to read and understand consent who are being discharged to home as the discharge destination.
- Nursing personnel (Registered Nurses or Licensed Practical Nurses) who are performing discharge instructions and procedures on the day of hospital discharge.
- Patients discharged to home with hospice care.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- FACTORIAL
- Arm && Interventions
Group Intervention Description implementation unit RN-RHDS + PT-RHDS + NIAF 3 implementation protocols implemented sequentially: 1. RN-RHDS: implementation of discharge readiness assessment by the discharging nurse 2. RN-RHDS+PT-RHDS: implementation of discharge readiness assessment by the discharging nurse which is informed by patient self-assessment of discharge readiness 3. RN-RHDS+PT-RHDS+NIAF: implementation of discharge readiness assessment by the discharging nurse which is informed by patient self-assessment of discharge readiness followed by documentation of nurse actions initiated in response to the assessment. Nurse are instructed that action must be taken if any assessment item scores less than 7 ( on a 10 point scale). implementation unit RN-RHDS protocol 3 implementation protocols implemented sequentially: 1. RN-RHDS: implementation of discharge readiness assessment by the discharging nurse 2. RN-RHDS+PT-RHDS: implementation of discharge readiness assessment by the discharging nurse which is informed by patient self-assessment of discharge readiness 3. RN-RHDS+PT-RHDS+NIAF: implementation of discharge readiness assessment by the discharging nurse which is informed by patient self-assessment of discharge readiness followed by documentation of nurse actions initiated in response to the assessment. Nurse are instructed that action must be taken if any assessment item scores less than 7 ( on a 10 point scale). implementation unit RN-RHDS+PT-RHDS protocol 3 implementation protocols implemented sequentially: 1. RN-RHDS: implementation of discharge readiness assessment by the discharging nurse 2. RN-RHDS+PT-RHDS: implementation of discharge readiness assessment by the discharging nurse which is informed by patient self-assessment of discharge readiness 3. RN-RHDS+PT-RHDS+NIAF: implementation of discharge readiness assessment by the discharging nurse which is informed by patient self-assessment of discharge readiness followed by documentation of nurse actions initiated in response to the assessment. Nurse are instructed that action must be taken if any assessment item scores less than 7 ( on a 10 point scale).
- Primary Outcome Measures
Name Time Method Post-discharge Utilization within 30 days after hospital discharge 30 days after hospital discharge Readmissions and Emergency Department Visits within 30 days after hospital discharge
- Secondary Outcome Measures
Name Time Method Nurse Initiated Action Form measured on day of hospital discharge typically 1 to 30 days after hospital admission Measures actions taken by the discharging nurse in response to discharge readiness assessment
Trial Locations
- Locations (1)
Marquette University
🇺🇸Milwaukee, Wisconsin, United States