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2. “Perfect Storm”of Patient Safety“
3. Principles of the RED:Creating the Toolkit
4. Eleven mutually reinforcing components:
? Medication Reconciliation
? Reconcile Plan with National Guidelines
? Follow-up Appointments
? Outstanding Tests and Studies
? Post-discharge Services
? Written discharge plan
? What to do if a problem arises
? Patient Education
? Assess patient understanding
? Dc summary to PCP
> Telephone Reinforcement
RED Checklist
10. In Hospital - Discharge Advocate (DA)
Nurse
Interact with care team – med rec and guidelines
Prepare the After Hospital Discharge Plan (AHCP)
Teach the AHCP
After Discharge – Clinical Pharmacist
Follow-up call @ 2-3 days
The DA and Pharm manual
Scripts for each task Intervention to Administer RED (1) coordinated post-discharge appointments for primary care, consultants, therapy, and outpatient tests; (2) scheduled appointments at times convenient for the subject and informed subject about what to do if an appointment needed to be changed; (3) helped determine a plan for transportation to appointments; (4) obtained pertinent diagnoses from the hospital record; (5) recorded the subject’s preferred outpatient pharmacy; (6) obtained a list of the subject’s discharge medications that were reconciled by the hospital team and updated in the subject’s ambulatory electronic medical record; (7) identified outstanding test results at the time of discharge; and (8) cross-checked the discharge plan with diagnosis-specific guidelines presented in the training manual, discussing possible discrepancies with the medical team before discharge. (1) coordinated post-discharge appointments for primary care, consultants, therapy, and outpatient tests; (2) scheduled appointments at times convenient for the subject and informed subject about what to do if an appointment needed to be changed; (3) helped determine a plan for transportation to appointments; (4) obtained pertinent diagnoses from the hospital record; (5) recorded the subject’s preferred outpatient pharmacy; (6) obtained a list of the subject’s discharge medications that were reconciled by the hospital team and updated in the subject’s ambulatory electronic medical record; (7) identified outstanding test results at the time of discharge; and (8) cross-checked the discharge plan with diagnosis-specific guidelines presented in the training manual, discussing possible discrepancies with the medical team before discharge.
11. Testing the RED Schematic
12. AHCP Evaluation:30 days post-discharge
13. AHCP Evaluation:30 days post-discharge
14. AHCP Evaluation:30 days post-discharge
15. Self-PerceivedReadiness for Discharge 30 days post-discharge
18. RED:
Successfully delivered using
RED protocols
AHCP
Improves ‘Readiness for Discharge’
Decreases hospital use
32% reduction
NNT = 7.9
Helps high hospital utilizers
40% reduction
Is Cost-Effective
$329 / patient
38 million discharges @ $753 billion x 32% eligible = 4 billion Conclusions from the RCT
19. Embodied Conversational Agent
Teaches the AHCP
Emulates face to face communication
Develops therapeutic alliance
Empathy
Gaze, posture, gesture
Competency Questions
Can drill down in med education
Maps of test sites and CHCs
Instructions – e.g., Lovenox, Glucometer
Workstation database
Connects to hospital IT
Prints AHCP
“Feeds” Louise
Concordancy Studies
Kiosk for patient access Major Problem: RN TimeCan Health IT Help?
27. Thank You AHRQ!