READI (Readiness Evaluation And Discharge Interventions) Study (READI)

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

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.

Study Overview

• Status: Completed
• Conditions: Discharge Transition of Patients Discharged to Home
• Intervention / Treatment: Other: RN-RHDS protocol; Other: RN-RHDS+PT-RHDS protocol; Other: RN-RHDS + PT-RHDS + NIAF

• Study Type: Interventional
• Enrollment (Actual): 189796
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Wisconsin
    • Milwaukee, Wisconsin, United States, 53201-1881
      • Marquette University

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:

• 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.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: HEALTH_SERVICES_RESEARCH
• Allocation: RANDOMIZED
• Interventional Model: FACTORIAL
• Masking: NONE

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
NO_INTERVENTION: Usual Care Control hospital unit; 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; 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; The discharging nurse assesses each patient being discharged home using the Readiness for Hospital Discharge Scale (RN version); Other: RN-RHDS+PT-RHDS protocol; 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); Other: RN-RHDS + PT-RHDS + NIAF; 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.

What is the study measuring?

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

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Readiness for Hospital Discharge Scale - RN version	Nurses perceptions of patient readiness for hospital discharge	measured on day of hospital discharge typically 1 to 30 days after hospital admission
Readiness for Hospital Discharge Scale - Patient version	Patient perception of discharge readiness	measured on day of hospital discharge typically 1 to 30 days after hospital admission

Collaborators and Investigators

• Sponsor: Marquette University
• Investigators: Principal Investigator: Marianne Weiss, DNSc, Marquette University

Publications and helpful links

General Publications

• Bahr SJ, Bang J, Yakusheva O, Bobay KL, Krejci J, Costa L, Hughes RG, Hamilton M, Siclovan DM, Weiss ME. Nurse Continuity at Discharge and Return to Hospital. Nurs Res. 2020 May/Jun;69(3):186-196. doi: 10.1097/NNR.0000000000000417.
• Weiss ME, Yakusheva O, Bobay KL, Costa L, Hughes RG, Nuccio S, Hamilton M, Bahr S, Siclovan D, Bang J; READI Site Investigators. Effect of Implementing Discharge Readiness Assessment in Adult Medical-Surgical Units on 30-Day Return to Hospital: The READI Randomized Clinical Trial. JAMA Netw Open. 2019 Jan 4;2(1):e187387. doi: 10.1001/jamanetworkopen.2018.7387.

Study record dates

Study Major Dates

• Study Start: July 1, 2014
• Primary Completion (ACTUAL): August 1, 2017
• Study Completion (ACTUAL): December 1, 2017

Study Registration Dates

• First Submitted: June 3, 2013
• First Submitted That Met QC Criteria: June 5, 2013
• First Posted (ESTIMATE): June 7, 2013

Study Record Updates

• Last Update Posted (ACTUAL): March 20, 2018
• Last Update Submitted That Met QC Criteria: March 16, 2018
• Last Verified: March 1, 2018

More Information

Terms related to this study

• Keywords: readmission; hospital discharge; discharge readiness; Emergency Department visits; Nurse assessment
• Other Study ID Numbers: ANCC2013-01