Project RED: Re‑engineering the discharge process

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Med rec a key step in AHRQ's Project RED interventions

Several years ago, Boston Medical Center’s Brian Jack, MD, and colleagues began looking at ways to help patients in the hospital care for themselves once they leave. With initial funding through a Partnerships in Implementing Patient Safety grant from the Agency for Healthcare Research and Quality (AHRQ), the Re-engineered Hospital Discharge (Project RED) intervention was born.

Project RED is a 12-step standardized approach to discharge planning and discharge education, where pharmacists play a key role in helping patients understand and adhere to their medications. More information on the program is available at www.bu.edu/fammed/projectred/index.html.

Understanding medications

Project RED re-engineers a hospital’s discharge workflow by providing specific steps to make the process safer. The RED intervention grew out of a randomized controlled trial published in the February 3, 2009, issue of the Annals of Internal Medicine. Jack and his team showed that patients who have a clear understanding of their postdischarge care instructions, including how to take their medicines and when to make follow-up appointments with their physicians, are 30% less likely to be readmitted or visit the emergency department than patients without this information.

One of the components studied in the trial was a phone call made by pharmacists a few days after the patient was discharged from the hospital. The call is designed to reinforce the patient’s after-hospital care plan and identify problems with drug therapy.

“We think this [element] is important,” said Jack, the principal investigator of the study and Professor and Chair of the Department of Family Medicine at Boston University School of Medicine and Boston Medical Center. “The evidence shows that when a PharmD makes that call, there is a reduction in posthospital utilization.”

Pharmacist’s role

Medication reconciliation is a critical step in the RED intervention. In addition to a postdischarge phone call, the pharmacist also verifies “the physician’s orders, reconciles the patient’s medications from home with the admission medications, [and] collaborates with the patient’s medical team regarding discharge medications,” said Diane D. Cousins, BSPharm, Health Scientist Administrator, Center for Quality Improvement and Patient Safety at AHRQ.

“Pharmacists have a lot of value to offer as part of the hospital team responsible for care transitions,” said David Schulke, Vice President, Research Programs, Health Research and Educational Trust, an affiliate of the American Hospital Association. “Pharmacists are ideally prepared to perform accurate medication reconciliation, and to use that interaction to teach patients about benefits and risks of their therapies.”

For more information about Project RED or to download the Project RED toolkit, which provides training tools such as strategies and systematic performance project plans to improve the discharge process, including the after-hospital care plan, visit www.ahrq.gov/news/kt/red/redfaq.htm.


Components of the RED intervention

Project RED includes the following 12 mutually reinforcing components designed to reduce rehospitalizations:

  • Ascertain need for and obtain language assistance.
  • Make appointments for follow-up medical appointments and postdischarge tests/labs.
  • Plan for the follow-up of results from lab tests or studies that are pending at discharge.
  • Organize postdischarge outpatient services and medical equipment.
  • Identify the correct medicines and a plan for the patient to obtain and take them.
  • Reconcile the discharge plan with national guidelines.
  • Teach a written discharge plan the patient can understand.
  • Educate the patient about his or her diagnosis.
  • Assess the degree of the patient’s understanding of the discharge plan.
  • Review with the patient what to do if a problem arises.
  • Expedite transmission of the discharge summary to clinicians accepting care of the patient.
  • Provide telephone reinforcement of the discharge plan.
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