Revisiting Project Re-Engineered Discharge (RED): The Impact of a Pharmacist Telephone Intervention on Hospital Readmission Rates

Abstract

Purpose: Project Re-Engineered Discharge is a discharge nurse education (DNE) and pharmacist follow-up telephone intervention protocol that was shown to decrease rehospitalization significantly. The specific value of the pharmacist intervention was not originally evaluated. The objective of this study was to determine the impact of a pharmacist telephone intervention during the transition of care process on the rate of unplanned hospitalization within 30 days of patient discharge.

Methods: A retrospective chart review was completed for patients who received DNE counseling and were discharged to home from the family medicine service at Boston Medical Center from July 2012 to May 2013. Patients were stratified into two groups: contacted/intervention and unable to contact/no intervention. The primary outcome was the rate of unplanned hospital utilization including emergency department visits and readmissions within 30 days of discharge. Secondary end points included number of pharmacist interventions and time spent on phone calls.

Results: A total of 401 patients were identified; 277 patients received a pharmacist telephone intervention, and 124 patients were unable to be contacted. Baseline characteristics did not differ between the two groups, with the exception of a higher prevalence of substance abuse in the nonintervention group (41.9% vs 21.3%, p<0.001). The rate of unplanned hospitalization (visits/patient) was significantly reduced in the intervention group, compared with the unable-to-contact group (0.227 vs 0.519, p<0.001). Pharmacists made a total of 128 interventions and spent an average of 22 minutes on each telephone intervention.

Conclusion: Patients unable to be contacted by a pharmacist after hospital discharge were more likely to be readmitted or visit the emergency department in the 30 days following discharge. A pharmacist telephone intervention as part of a comprehensive discharge protocol can have a positive impact on patients during the transition of care process by reducing incidence of unplanned hospital utilization.

Keywords: Project RED; patient discharge; patient readmission; pharmacist; telephone call; transition of care.