The CARS Study: Communicating About Readiness (for Discharge)

The purpose of this study is to improve the experience of discharge of adult medical surgical patients through improved discharge preparation communication between patients and care team members, with subsequent improvement in the post-discharge experience. Obtaining multiple perspectives on discharge readiness creates the opportunity for patient and care team to partner in identifying deficiencies in discharge readiness that warrant anticipatory, compensatory, or corrective interventions prior to discharge, with the goal of averting post-discharge problems and utilization. The results will also inform development and translation of tools for assessment of discharge readiness to clinical care environments.

Study Overview

• Status: Completed
• Conditions: Hospital Discharge Communication Processes
• Intervention / Treatment: Other: Health Team Educational Intervention

Detailed Description

Specific Aims are to:

1. Describe patterns of communication about discharge and collaboration among members of the health care team
2. Conduct psychometric testing of 3 forms of the Readiness for Hospital Discharge Scale (RHDS - MD, RN, Patient)
3. Describe relationships between care team communication, patient perceptions of quality of discharge preparation and perceived readiness for discharge, care team (RN and MD) assessments of discharge readiness, and post-discharge outcome ( post-discharge coping difficulty, Emergency Department (ED) use, and 30 day readmission.
4. Determine the impact of an intervention with the inpatient care team to improve discharge preparation communication.

H1: Patient perceptions of discharge readiness, post-discharge coping difficulty, ED use and readmission will improve following a care team educational intervention about discharge preparation, compared to pre-intervention baseline measures.

H2: Care team members will report improved frequency and amount of discharge preparation communication following a care team educational intervention about discharge preparation, compared to pre-intervention baseline measures.

H3: RN-MD collaboration will increase following a care team educational intervention about discharge preparation, compared to pre-intervention baseline measures

• Study Type: Interventional
• Enrollment (Actual): 604
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Wisconsin
    • Milwaukee, Wisconsin, United States, 53226
      • Froedtert Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• inpatient care team members from 2 nursing units of an academic medical center: Attending physician, resident, medical students, mid-level providers, staff RNs, and case managers/discharge coordinators
• adult medical-surgical patients admitted the 2 nursing units who are at least 18 years of age, speak English, and discharged directly home

Exclusion Criteria:

• patient discharged home with hospice care
• patients not discharged directly home
• decisionally incapacitated patients

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Non-Randomized
• Interventional Model: Sequential Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Health team educational intervention; Agency for Healthcare Research and Quality (AHRQ) TeamSTEPPS approach will be used to redesign health team communication processes regarding preparation for discharge. This redesign will be followed by education for all health team members.	Other: Health Team Educational Intervention; AHRQ TeamStepps processes will be used to redesign health team discharge communication processes and an educational intervention for health care team members
No Intervention: Control pre-intervention; Usual care control before implementation of the health team communication intervention

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Readmission	Readmission within the 30 days after hospital discharge	30 days post discharge
Emergency Department visits	ED visits within the 30 days after hospital discharge	30 days post discharge

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Post-discharge Coping Difficulty Scale	Coping difficulty after hospital discharge measured using the Post-Discharge Coping Difficulty Scale is collected via telephone followup between 14 and 21 days after hospital discharge	14 to 21 days post-hospitalization

Collaborators and Investigators

• Sponsor: Marquette University
• Collaborators: Froedtert Hospital
• Investigators: Principal Investigator: Marianne Weiss, DNSc RN, Marquette Unoversity; Principal Investigator: Kristi Opper, MS RN, Froedtert Hospital

Study record dates

Study Major Dates

• Study Start (Actual): March 1, 2014
• Primary Completion (Actual): May 1, 2016
• Study Completion (Actual): May 1, 2016

Study Registration Dates

• First Submitted: April 26, 2013
• First Submitted That Met QC Criteria: June 5, 2013
• First Posted (Estimate): June 7, 2013

Study Record Updates

• Last Update Posted (Actual): April 18, 2019
• Last Update Submitted That Met QC Criteria: April 16, 2019
• Last Verified: April 1, 2019

More Information

Terms related to this study

• Other Study ID Numbers: PRO00019092