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RE-Engineering Discharge: Putting Communication Front and Center


The Re-Engineered Discharge (RED) is a patient-centered, standardized approach to discharge planning. Initially developed at Boston University Medical Center with funding from the Agency for Healthcare Research and Quality (AHRQ), the RED “improves patient preparedness for self-care and reduces preventable readmissions.”  AHRQ has published a new RED Toolkit to assist hospitals, particularly those that serve diverse populations, to replicate the RED. It adds a twelfth component to the RED that can significantly enhance a hospital’s ability to improve services for patients with limited English proficiency – ascertaining the need for and providing language assistance. The new RED Toolkit also includes Tool 4: How to Deliver the Re-Engineered Discharge to Diverse Populations, which speaks directly to language access issues.

In a recent conversation, Cindy Brach, Senior Health Policy Researcher at AHRQ talked about the value of the RED Toolkit and, specifically, why a tool for diverse populations was necessary.

Q. So what is motivating hospitals to look at the discharge process in new ways?
A. While CMS payment changes have been the impetus for a lot of interest in this area, hospitals want to do well by their patients. The focus on readmissions has gotten hospitals thinking about how well we prepare our patients to go home and what happens after they walk out the door.

Q. Why should hospitals be looking specifically at the RED Toolkit?
A. The RED team realized that to better prepare patients to be successful after leaving the hospital, the discharge process really needed a fundamental overhaul. They came up with a number of evidence-based elements informed by a health literacy perspective, a perspective that emphasizes clearly communicating with the patient at multiple points so they can really understand their condition and how to take care of themselves. The RED approach is all about confirming understanding at every step of the discharge process so you can expose areas where communication may potentially break down. This occurs throughout the patient’s stay and not just in the last hour as they are trying to get out the door.

Q. What about the need for Tool 4 in particular?
A. The RED has evolved over the past seven years as hospitals have been adapting RED processes for their populations. For example, San Francisco General Hospital translated the After Hospital Care Plan into Spanish and Chinese. We knew hospitals were dealing with LEP patients and the Toolkit needed to address this. We struggled for a while deciding whether or not addressing diversity should be a separate tool or integrated into the others. We came to the conclusion we needed to do both – stressing adjustments for diverse populations as part of each component of the Toolkit, but also including extra enrichment into a separate tool. So you’ll see the importance of addressing language and cultural differences noted throughout the toolkit, with references back to Tool 4 for additional information.

I think the biggest breakthrough related to serving patients with limited English proficiency is adding that twelfth component. Now, when hospital staff want to follow the RED processes, they look at that that list of components and they see right at the top level: one of the things I have to do is this language assistance piece. It’s an essential component.

Q. Do you see the Toolkit as a means to introduce more staff to cross-cultural communication essentials?
A. I undertook this project not because I was a readmission specialist or a discharge specialist, but because reducing readmissions is a really urgent priority, and interventions are going to miss the mark unless they address diverse populations. So we have an opportunity to expose a new set of individuals to the fundamentals of cultural and linguistic competency. When they use the RED Toolkit, they can realize ‘oh yeah, when I’m doing this, we may not understand each other unless I’m follow these essential steps.’ It’s a good start in the right direction.

Get a copy the free RED Toolkit at:


Internet Citation: Project RED (Re-Engineered Discharge) Training Program. March 2013. Agency for Healthcare Research and Quality, Rockville, MD.

The AHRQ website provides a number of compelling reasons for hospitals to use the RED Toolkit, including decreases in readmissions by 25 percent.

Internet Citation: Tool 4: How To Deliver the Re-Engineered Discharge to Diverse Populations: Re-Engineered Discharge (RED) Toolkit. March 2013. Agency for Healthcare Research and Quality, Rockville, MD.

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