LR15 / Clinical Risk Management (CRM) Practice on Re-engineered Discharge (RED)

Type of Patient Safety Practice
Clinical Risk Management Practice (CRMP)
Related practices from PaSQ database
“Best fit” category of the reported practice


System resilience
Patient safety theme the SCP/clinical risk management practice is aimed at
Re-engineered discharge (RED)[1]
Objective of the CRM practice
Pre-discharge interventions have shown a reduction in hospital readmission rates and cost [7-9], emergency department visits[3], and postdischarge adverse events[10], while some interventions have shown little or no effect[11-14].
Short description of the CRM practice, including any references for further information
The RED intervention has 3 core elements: the Nurse discharge advocate (DA), the after-hospital care plan (AHCP) and the follow-up telephone call by the pharmacist[1].
Innovator of the SCP, country of origin
United States
Involved health care staff
Nurses as Nurse discharge advocates (DAs); Pharmacists
Tested in which countries/health care systems, health care context(s) and/or clinical specialty/specialties, including references
Large urban teaching hospital/Boston, Massachusetts. United States
Summary of evidence for effectiveness, including references
The RED intervention reduced hospital utilisation (emergency department visits and readmissions combined) within 30 days of discharge by 30%, improved patient self-perceived preparation for discharge and increased primary care provider follow- up[1]. Peridischarge interventions have shown improved primary care provider (PCP) follow-up and outpatient work-ups[2] and higher patient satisfaction[3].
Summary of evidence for transferability (transferability across health care systems or health care contexts or clinical specialties), including references
Hospital discahrge was identified by the National Quality Forum Consensus Standards Maintenance Committee as a critical area for improvement. As a result, the National Quality Forum ‘Safe Practice’ was based largely on the principles of the RED programme[4]. Many hospitals are implementing multifaceted programmes to improve discharge planning and transition of care, often involving pharmacists[5]. A Swedish study[6] reported fewer hospital and emergency department visits by older patients who received medication reconciliation intervention by unit-based pharmacists before discharge.
Summary of available information on feasibility, including references
Existing implementation tools, including references
Reengineered discharge (RED) process[15,16]
Potential for/description of patient involvement in the CRM practice, including references
Patients were educated and involved in the discharge planning.
Bibliography (for each reference: author(s), year, title, journal/internet link, page(s))
[1] Jack BW, Chetty VK, Anthony D, Greenwald JL, Sanchez GM, Johnson AE, Forsythe SR, O’Donnell JK, Paasche-Orlow MK, Manasseh C, Martin S, Culpepper L (2009) A reengineered hospital discharge program to decrease rehospitalization: a randomized trial. Ann Intern Med 150:178-187

[2] Balaban RB, Weissman JS, Samuel PA, Woolhandler S (2008) Redefining and redesigning hospital discharge to enhance patient care: a randomized controlled study. J Gen Intern Med 23:1228-1233

[3] Dudas V, Bookwalter T, Kerr KM, Pantilat SZ (2001) The impact of follow-up telephone calls to patients after hospitalization. Am J Med 111:26S-30S

[4] National Quality Forum. Safe practices for better healthcare 2009 update. A consensus report. 2009. Washington Dc, National Quality Forum.

[5] Haynes KT, Oberne A, Cawthon C, and Kripalani S. Pharmacist’s recommendations to improve care transitions. Ann Pharmacother 46, 1152-1159. 2012.

[6] Gillespie U, Alassaad A, Henrohn D, Garmo H, Hammarlund-Udenaes M, Toss H, Kettis-Lindblad A, Melhus H, and Mörlin C. A comprehensive pharmacist intervention to reduce morbidity in patients 80 years or older: a randomized controlled trial. Arch Intern Med 169(9), 894. 2009.

[7] Coleman EA, Parry C, Chalmers S, Min SJ (2006) The care transitions intervention: results of a randomized controlled trial. Arch Intern Med 166:1822-1828

[8] Naylor MD, Brooten D, Campbell R, Jacobsen BS, Mezey MD, Pauly MV, Schwartz JS (1999) Comprehensive discharge planning and home follow-up of hospitalized elders: a randomized clinical trial. JAMA 281:613-620

[9] Anderson C, Deepak BV, Amoateng-Adjepong Y, Zarich S (2005) Benefits of comprehensive inpatient education and discharge planning combined with outpatient support in elderly patients with congestive heart failure. Congest Heart Fail 11:315-321

[10] Schnipper JL, Kirwin JL, Cotugno MC, Wahlstrom SA, Brown BA, Tarvin E, Kachalia A, Horng M, Roy CL, McKean SC, Bates DW (2006) Role of pharmacist counseling in preventing adverse drug events after hospitalization. Arch Intern Med 166:565-571

[11] Siu AL, Kravitz RL, Keeler E, Hemmerling K, Kington R, Davis JW, Mitchell A, Burton TM, Morgenstern H, Beers MH, Reuben DB (1996) Postdischarge geriatric assessment of hospitalized frail elderly patients. Arch Intern Med 156:76-81

[12] Holland R, Lenaghan E, Harvey I, Smith R, Shepstone L, Lipp A, Christou M, Evans D, Hand C (2005) Does home based medication review keep older people out of hospital? The HOMER randomised controlled trial. BMJ 330:293

[13] Naylor M, Brooten D, Jones R, Lavizzo-Mourey R, Mezey M, Pauly M (1994) Comprehensive discharge planning for the hospitalized elderly. A randomized clinical trial. Ann Intern Med 120:999-1006

[14] Shepperd S, McClaran J, Phillips CO, Lannin NA, Clemson LM, McCluskey A, Cameron ID, Barras SL (2010) Discharge planning from hospital to home. Cochrane Database Syst RevCD000313

[15] Greenwald JL, Denham CR, Jack BW (2007) The hospital discharge: a review of a high risk care transition with highlights of a reengineered discharge process. J Patient Saf 3:97-106

[16] Anthony D, Chetty VK, Kartha A, McKenna K, DePaoli RM, Jack B (2008) Re-engineering the Hospital Discharge: An Example of a Multifaceted Process Evaluation. In: Henriksen K, Battles JB, Keyes MA, Grady ML (eds) Advances in patient safety: New directions and alternative approaches. Agency for Healthcare Research and Quality, Rockville, MD,

Any additional information on the CRM (e.g. implementation barriers and drivers)