READI (Readiness Evaluation And Discharge Interventions) Study

Study Overview
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Brief Summary
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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.

Official Title
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READI (Readiness Evaluation And Discharge Interventions): Implementation as a Standard Nursing Practice for Hospital Discharge

Conditions
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Discharge Transition of Patients Discharged to Home

Intervention / Treatment
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* Other: RN-RHDS protocol
* Other: RN-RHDS+PT-RHDS protocol
* Other: RN-RHDS + PT-RHDS + NIAF


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 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. Exclusion Criteria: Patients discharged to home with hospice care.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Factorial Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Usual Care Control hospital unit<br>This study involves implementation of interventions across entire hospital units. This arm is a usual care control unit paired to the intervention unit. | |
| Experimental: implementation unit<br>3 implementation protocols implemented sequentially: RN-RHDS: implementation of discharge readiness assessment by the discharging nurse RN-RHDS+PT-RHDS: implementation of discharge readiness assessment by the discharging nurse which is informed by patient self-assessment of discharge readiness 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). | Other: RN-RHDS protocol<br>* The discharging nurse assesses each patient being discharged home using the Readiness for Hospital Discharge Scale (RN version)<br>Other: RN-RHDS+PT-RHDS protocol<br>* The discharging nurse obtains and reviews patient self-report of discharge readiness using the Readiness for Hospital Discharge Scale - Patient version and then completes the Readiness for Hospital Discharge Scale (RN version)<br>Other: RN-RHDS + PT-RHDS + NIAF<br>* The discharging nurse assesses each patient being discharged home using the Readiness for Hospital Discharge Scale (RN version)after reviewing the patients self-perception of discharge readiness (PT-RHDS) and then records any actions taken in response to the discharge readiness assessment on the Nurse Initiated Action form (NIAF). When any item on the RN-RHDS is less than 7, an action is required.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Post-discharge Utilization within 30 days after hospital discharge | Readmissions and Emergency Department Visits within 30 days after hospital discharge | 30 days after hospital discharge | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Nurse Initiated Action Form | Measures actions taken by the discharging nurse in response to discharge readiness assessment | measured on day of hospital discharge typically 1 to 30 days after hospital admission | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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hospital discharge, discharge readiness, readmission, Emergency Department visits, Nurse assessment