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Patel and Dickerson
an important factor in rehospitalization. Improving communication and coordination of care during transitions can significantly reduce readmission rates.1 HF is the most common
indication for hospitalization due to exacerbation of a
chronic condition among adults aged 65 years and older in
the United States.3 Hospitalizations due to HF have more
than tripled over the past 2 decades. The annual cost associated with caring for heart patients is estimated to be nearly
$20 billion and is primarily attributed to frequent hospital
readmissions due to decompensation. Factors associated
with readmission due to an exacerbation of HF symptoms
include advanced age, prior hospital admission, increased
length of hospital stay, increasing severity of illness, and
medical comorbidities.3 One in 5 hospitalizations is complicated by a postdischarge adverse event, some of which may
lead to preventable emergency department visits or readmissions. In a randomized prospective study, 23% patients
experienced at least 1 adverse event post discharge. Of those
reported adverse events, 72% were medication related.4
Another prospective cohort study showed similar results.
They found 19% patients had adverse events after discharge
and 66% of those events were drug events.5 Project
Re-Engineered Discharge (RED) was developed by a
research group at the Boston University Medical Center to
promote patient safety and reduce hospital readmissions by
streamlining the hospital discharge process.6 RED components consist of 12 mutually reinforcing actions employed
by an interdisciplinary team throughout the hospital stay for
more effective transitions at discharge. These components
are follow-up medical/lab appointments, follow-up of pending test/study results, organize postdischarge services and
equipment, identify correct medications and develop personalized patient plan, reconcile discharge plan with national
guidelines, teach a written discharge plan to patients with
list of medications, educate patient about diagnosis, assess
patient's understanding, transmit discharge summary to clinicians, discharge medication counseling, and reinforcement of discharge plan.7 A randomized trial, funded by the
Agency for Healthcare Research and Quality, showed that
Project RED reduces readmissions by approximately 30%.
In addition, the study showed a higher primary care physician (PCP) follow-up rate (18%) in the intervention group as
compared with the usual care (nonintervention group)
patients. Last, there was a cost savings of about 34% ($412
per patient) in the intervention group.8 Another intervention
study with a historical control at a skilled nursing facility
adapted Project RED to their transition of care. The rate of
hospitalization 30 days after discharge from the skilled
nursing facility for participants prior to the intervention was
18.9% and for participants after the intervention was 10.5%.
In addition, more patients in the intervention group had
attended an outpatient appointment within 30 days of discharge (70.5% vs 52.0%).9 The purpose of this study is to
assess the impact of the implementation of Project RED on
the incidence of hospital readmissions, all-cause mortality,
PCP follow-up rate, and cost savings for patients with HF at
an academic Veterans Affairs hospital.
Methods
This was a retrospective, randomized, cohort study. The study
was approved by Central Arkansas Veterans Healthcare
System (CAVHS) Department of Veterans Affairs Institutional
Review Board and CAVHS Research and Development
Committee. CAVHS is a tertiary care facility, ranked as one
of the largest and busiest Veterans Affairs medical centers in
the country. The health system includes both inpatient (medical as well as surgical units) and outpatient services for
Veterans. Current inpatient teams include hospitalists, clinical
team coordinators, nurses, clinical pharmacists, dietitians,
and social workers. The CAVHS Computerized Patient
Recording System database was utilized for the study. Patient
list with admission International Classification of Diseases,
Ninth Revision (ICD-9) codes of 428, 428.1, 428.2, 428.21,
428.22, 428.23, 428.3, 428.32, 428.33, 428.4, 428.41, 428.42,
428.43, and 428.9 associated with HF were extracted. Project
RED was implemented on July 1, 2014. All components of
Project RED implemented by the hospital are included in the
appendix. The chart review was conducted in 2 phases. Phase
1, called the pre-Project RED phase, consisted of data
extracted 6 months before the implementation of Project RED
from February 1, 2014 to July 31, 2014. Phase 2, called the
post-Project RED phase, consisted of data extracted 4 months
after the implementation of Project RED from August 1,
2014, to November 30, 2014.
The following patient information was extracted: age,
social security number, gender, race, housing status post discharge, left ventricular ejection fraction, date of hospital
admission, date of hospital discharge, length of hospital stay,
type of hospital utilization (emergency department vs readmission), date of primary care appointment scheduled at the
time of discharge, date of primary care appointment attended
post discharge, and cost savings. The study was conducted in
accordance with the ethical standards of the responsible
committee on human experimentation and all investigators
complied with the principles of the Belmont Report.
The study population for the pre-Project RED phase
included no more than 100 adult veterans, aged 18 years and
older, who were admitted for HF exacerbation between
February 1, 2014, and July 31, 2014. The study population
for the post-Project RED phase included no more than 50
adult veterans, aged 18 years and older, who were admitted
for HF exacerbation between August 1, 2014, and November
30, 2014, and had received the education component of
Project RED. Patients who did not have a documented education note post discharge in the post-Project RED phase
were excluded from the study. All patients with an admission
left ventricular ejection fraction of >55% were also excluded
from the study. Patients, who received Project RED education versus those who did not, were compared in the study.
Table of Contents for the Digital Edition of Hospital Pharmacy - July/August 2018
Ed Board
TOC
Antibiotic Stewardship: The Health of the World Depends on It
ISMP Medication Error Report Analysis: CycloSPORINE Dispensing Errors
ISMP Adverse Drug Reactions
Summaries of Safety Labeling Changes Approved By FDA: Boxed Warnings Highlights January-March 2018
Restructuring a Pharmacy Department: Leadership Strategies for Managing Organizational Change
Angiotensin II
RxLegal: A Rapid Review of Right-To-Try
New Medications in the Treatment of Hereditary Transthyretin Amyloidosis
Significant Published Articles for Pharmacy Nutrition Support Practice in 2017
Utilization of Lean Techniques in Pharmacy Residency Training: Modifying the PGY1 Management and Leadership Experience
Impact of a Clinical Decision Support Tool on Cancer Pain Management in Opioid-Tolerant Inpatients
Lyme Carditis: A Case Report and Review of Management
Impact of the Implementation of Project Re-Engineered Discharge for Heart Failure patients at a Veterans Affairs Hospital at the Central Arkansas Veterans Healthcare System
Evaluation of Oritavancin Use at a Community Hospital
Hospital Pharmacy - July/August 2018 - Cover1
Hospital Pharmacy - July/August 2018 - Cover2
Hospital Pharmacy - July/August 2018 - 201
Hospital Pharmacy - July/August 2018 - 202
Hospital Pharmacy - July/August 2018 - 203
Hospital Pharmacy - July/August 2018 - 204
Hospital Pharmacy - July/August 2018 - 205
Hospital Pharmacy - July/August 2018 - Ed Board
Hospital Pharmacy - July/August 2018 - 207
Hospital Pharmacy - July/August 2018 - TOC
Hospital Pharmacy - July/August 2018 - 209
Hospital Pharmacy - July/August 2018 - 210
Hospital Pharmacy - July/August 2018 - 211
Hospital Pharmacy - July/August 2018 - 212
Hospital Pharmacy - July/August 2018 - 213
Hospital Pharmacy - July/August 2018 - Antibiotic Stewardship: The Health of the World Depends on It
Hospital Pharmacy - July/August 2018 - 215
Hospital Pharmacy - July/August 2018 - 216
Hospital Pharmacy - July/August 2018 - ISMP Medication Error Report Analysis: CycloSPORINE Dispensing Errors
Hospital Pharmacy - July/August 2018 - 218
Hospital Pharmacy - July/August 2018 - 219
Hospital Pharmacy - July/August 2018 - ISMP Adverse Drug Reactions
Hospital Pharmacy - July/August 2018 - 221
Hospital Pharmacy - July/August 2018 - 222
Hospital Pharmacy - July/August 2018 - Summaries of Safety Labeling Changes Approved By FDA: Boxed Warnings Highlights January-March 2018
Hospital Pharmacy - July/August 2018 - 224
Hospital Pharmacy - July/August 2018 - Restructuring a Pharmacy Department: Leadership Strategies for Managing Organizational Change
Hospital Pharmacy - July/August 2018 - 226
Hospital Pharmacy - July/August 2018 - 227
Hospital Pharmacy - July/August 2018 - 228
Hospital Pharmacy - July/August 2018 - 229
Hospital Pharmacy - July/August 2018 - Angiotensin II
Hospital Pharmacy - July/August 2018 - 231
Hospital Pharmacy - July/August 2018 - 232
Hospital Pharmacy - July/August 2018 - 233
Hospital Pharmacy - July/August 2018 - RxLegal: A Rapid Review of Right-To-Try
Hospital Pharmacy - July/August 2018 - 235
Hospital Pharmacy - July/August 2018 - New Medications in the Treatment of Hereditary Transthyretin Amyloidosis
Hospital Pharmacy - July/August 2018 - 237
Hospital Pharmacy - July/August 2018 - 238
Hospital Pharmacy - July/August 2018 - Significant Published Articles for Pharmacy Nutrition Support Practice in 2017
Hospital Pharmacy - July/August 2018 - 240
Hospital Pharmacy - July/August 2018 - 241
Hospital Pharmacy - July/August 2018 - 242
Hospital Pharmacy - July/August 2018 - 243
Hospital Pharmacy - July/August 2018 - 244
Hospital Pharmacy - July/August 2018 - 245
Hospital Pharmacy - July/August 2018 - 246
Hospital Pharmacy - July/August 2018 - Utilization of Lean Techniques in Pharmacy Residency Training: Modifying the PGY1 Management and Leadership Experience
Hospital Pharmacy - July/August 2018 - 248
Hospital Pharmacy - July/August 2018 - 249
Hospital Pharmacy - July/August 2018 - 250
Hospital Pharmacy - July/August 2018 - 251
Hospital Pharmacy - July/August 2018 - 252
Hospital Pharmacy - July/August 2018 - 253
Hospital Pharmacy - July/August 2018 - 254
Hospital Pharmacy - July/August 2018 - 255
Hospital Pharmacy - July/August 2018 - Impact of a Clinical Decision Support Tool on Cancer Pain Management in Opioid-Tolerant Inpatients
Hospital Pharmacy - July/August 2018 - 257
Hospital Pharmacy - July/August 2018 - 258
Hospital Pharmacy - July/August 2018 - 259
Hospital Pharmacy - July/August 2018 - 260
Hospital Pharmacy - July/August 2018 - 261
Hospital Pharmacy - July/August 2018 - 262
Hospital Pharmacy - July/August 2018 - Lyme Carditis: A Case Report and Review of Management
Hospital Pharmacy - July/August 2018 - 264
Hospital Pharmacy - July/August 2018 - 265
Hospital Pharmacy - July/August 2018 - Impact of the Implementation of Project Re-Engineered Discharge for Heart Failure patients at a Veterans Affairs Hospital at the Central Arkansas Veterans Healthcare System
Hospital Pharmacy - July/August 2018 - 267
Hospital Pharmacy - July/August 2018 - 268
Hospital Pharmacy - July/August 2018 - 269
Hospital Pharmacy - July/August 2018 - 270
Hospital Pharmacy - July/August 2018 - 271
Hospital Pharmacy - July/August 2018 - Evaluation of Oritavancin Use at a Community Hospital
Hospital Pharmacy - July/August 2018 - 273
Hospital Pharmacy - July/August 2018 - 274
Hospital Pharmacy - July/August 2018 - 275
Hospital Pharmacy - July/August 2018 - 276
Hospital Pharmacy - July/August 2018 - Cover3
Hospital Pharmacy - July/August 2018 - Cover4
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