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Readmission-reducing RED Protocol Adoption Lagging

By John Commins  
   January 26, 2016

The creators of the 12-step Re-Engineered Discharge protocol say it saves money, but hasn't yet been widely or fully adopted. Follow-up studies have shown that problems arise when RED is diluted.

Five years after its launch, the Re-Engineered Discharge protocol is struggling to catch hold in the nation's hospitals.

The creators of the 12-step discharge protocol, which took seven years to compile, say it reduces readmissions and saves money, but hasn't yet been widely adopted.


Suzanne Mitchell, MD

"That's a good question," Suzanne Mitchell, MD, a RED co-creator, said when asked how many hospitals were using RED. "What we have seen mostly is hospitals adapting and cherry picking from a number of different programs. They might take a couple of items from RED and marry them with the Eric Coleman model, which uses a coach that works with patients and caregivers post discharge."

"Because hospitals have mixed and matched based on what they felt they had available and what was familiar to them, it is hard to know who implemented RED as an entire package," says Mitchell, who is also an assistant professor of Family Medicine at Boston University School of Medicine and a physician in Family Medicine at Boston Medical Center.

In fact, even though Mitchell and her BU colleagues developed RED, the protocol isn't widely used at Boston Medical Center.

"BMC has been using adapted versions of RED. It is not disseminated throughout the hospital, but we use it on our designated floor for family medicine, a team-based model," Mitchell says. "It's the same as in many places. A lot of it has to do with the way payments are still based on fee for service," she says.

"We are in a very rapid change in terms of being in alignment and accountable care. But it takes resources to change the way you do things and people don't always feel that RED is going to benefit their particular population."

Mitchell says it's not uncommon to see three or four readmissions initiatives operating simultaneously at the same hospital. "Nobody knows about the other ones and they are all focusing on different patient problems," she says.

John Commins is a senior editor at HealthLeaders.

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