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

This study is not yet open for participant recruitment. (see Contacts and Locations)
Verified June 2013 by Marquette University
Sponsor:
Information provided by (Responsible Party):
Marianne Weiss, Marquette University
ClinicalTrials.gov Identifier:
NCT01873118
First received: June 3, 2013
Last updated: June 5, 2013
Last verified: June 2013
  Purpose

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.


Condition Intervention
Discharge Transition of Patients Discharged to Home
Other: RN-RHDS protocol
Other: RN-RHDS+PT-RHDS protocol
Other: RN-RHDS + PT-RHDS + NIAF

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Factorial Assignment
Masking: Open Label
Primary Purpose: Health Services Research
Official Title: READI (Readiness Evaluation And Discharge Interventions): Implementation as a Standard Nursing Practice for Hospital Discharge

Resource links provided by NLM:


Further study details as provided by Marquette University:

Primary Outcome Measures:
  • Post-discharge Utilization within 30 days after hospital discharge [ Time Frame: 30 days after hospital discharge ] [ Designated as safety issue: No ]
    Readmissions and Emergency Department Visits within 30 days after hospital discharge


Secondary Outcome Measures:
  • Nurse Initiated Action Form [ Time Frame: measured on day of hospital discharge typically 1 to 30 days after hospital admission ] [ Designated as safety issue: No ]
    Measures actions taken by the discharging nurse in response to discharge readiness assessment


Other Outcome Measures:
  • Readiness for Hospital Discharge Scale - RN version [ Time Frame: measured on day of hospital discharge typically 1 to 30 days after hospital admission ] [ Designated as safety issue: No ]
    Nurses perceptions of patient readiness for hospital discharge

  • Readiness for Hospital Discharge Scale - Patient version [ Time Frame: measured on day of hospital discharge typically 1 to 30 days after hospital admission ] [ Designated as safety issue: No ]
    Patient perception of discharge readiness


Estimated Enrollment: 24000
Study Start Date: January 2014
Estimated Study Completion Date: June 2016
Estimated Primary Completion Date: August 2015 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
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:

  1. RN-RHDS: implementation of discharge readiness assessment by the discharging nurse
  2. RN-RHDS+PT-RHDS: implementation of discharge readiness assessment by the discharging nurse which is informed by patient self-assessment of discharge readiness
  3. 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.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

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.
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01873118

Contacts
Contact: Marianne Weiss, DNSc 414-288-3855 marianne.weiss@marquette.edu

Sponsors and Collaborators
Marquette University
Investigators
Principal Investigator: Marianne Weiss, DNSc Marquette University
  More Information

No publications provided

Responsible Party: Marianne Weiss, Associate Professor, Marquette University
ClinicalTrials.gov Identifier: NCT01873118     History of Changes
Other Study ID Numbers: ANCC2013-01
Study First Received: June 3, 2013
Last Updated: June 5, 2013
Health Authority: United States: Institutional Review Board

Keywords provided by Marquette University:
hospital discharge
discharge readiness
readmission
Emergency Department visits
Nurse assessment

ClinicalTrials.gov processed this record on October 21, 2014