Evaluating the Implementation of Project Re-Engineered Discharge (RED) in Five Veterans Health Administration (VHA) Hospitals

Background Improving the process of hospital discharge is a critical priority. Interventions to improve care transitions have been shown to reduce the rate of early unplanned readmissions, and consequently, there is growing interest in improving transitions of care between hospital and home through appropriate interventions. Project Re-Engineered Discharge (RED) has shown promise in strengthening the discharge process. Although studies have analyzed the implementationof RED among private-sector hospitals, little is known about how hospitals in the Veterans Health Administration(VHA) have implementedRED. The RED implementationprocess was evaluated in five VHA hospitals, and contextual factors that may impede or facilitate the undertakingof RED were identified. Methods A qualitative evaluation of VHA hospitals' implementationof RED was conducted through semistructured telephone interviews with personnel involved in RED implementation. Qualitative data from these interviews were coded and used to compare implementationactivities across the five sites. In addition guided by the Practical, Robust Implementationand Sustainability Model (PRISM), cross-site analyses of the contextual factors were conducted using a consensus process. Results Progress and adherence to the RED toolkit implementationsteps and intervention components varied across study sites. A majority of contextual factors identified were positive influences on sites' implementation. Conclusion Although the study sites were able to tailor and implementRED because of its adaptability, redesigning discharge processes is a significant undertaking, requiring additional support/resources to incorporate into an organization's existing practices. Lessons learned from the study should be useful to both VHA and private-sector hospitals interested in implementingRED and undertakinga care transition intervention.