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Virtual Discharge Assistant Cuts Readmissions, Costs

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   March 08, 2011

Now that patient satisfaction and patient experience are set to be tied to reimbursement, nurse leaders are looking for innovative solutions to improve these scores without adding tasks to already overworked staff.

One technological innovation that may become more common is the virtual discharge assistant. (Yes, companies may term these robots "discharge nurses," but as I wrote last week, using the term to refer to anything other than a member of the profession of nursing does a disservice to the profession.)

A virtual discharge advocate, named Louise has proven so successful in a pilot program at Boston Medical Center that 74% of patients in the study preferred to receive information from Louise rather than from a nurse or a physician.

The program is funded by the Agency for Healthcare Research and Quality to improve the patient discharge process. The Project Re-Engineered Hospital Discharge (Project RED) found that a thorough and well-implemented discharge plan can reduce readmissions by 30% and decrease costs per patient by $412.

Boston University Medical Center researchers identified the most common problems with discharge and made improving the problem areas the focus of Project RED. The researchers then identified 750 patients at Boston Medical Center and split them into two groups. One group received standard care. The other group received care based on the Project RED principles.

Project RED patients used a discharge advocate who collated all their information and entered it into a software program that produced an After Hospital Care Plan (AHCP) for each patient.

AHCP is a thorough discharge summary. Along with information about medications and follow-up appointments, it contains images of pills and detailed instructions on when and how to take them. It also has color coded calendar information for follow up appointments, including directions to the medical facilities.

The discharge advocate reviews the AHCP with each patient to ensure thorough education and understanding. This is where the virtual component comes in. While vital that nurses talk with patients before discharge, much of patient education can be routine passing of information that is time-consuming and detracts nurses from other areas of patient care. The Project RED team brought in Louise to educate.

Louise is an animated face on a computer screen, complete with a touchscreen to allow patients to ask and answer questions, who simulates conversations with patients. She was modeled on actual human interactions between nurses and patients.

Louise reviews the AHCP with patients and her virtual face expresses emotions and even empathy with patients. She has endless patience and can cover information as many times as is necessary for patients to feel that they understand their discharge instructions. As she goes along, Louise asks patients questions to ensure they are actively participating and will present a list of options from which patients must select the right answer.

Louise proved extremely popular in the study, with patients noting that they like being able to sit as long as they want to with Louise and not feel rushed that a busy nurse or physician has to move on to other patients. In addition, many patients find it easier to answer some questions truthfully—for example, about whether they smoke—than with a live person.

Participants in the Project RED program reported feeling much more prepared for discharge and the study had excellent outcomes, preventing one ED readmission for every 7.3 patients in the study. The AHRQ is supplying funding to implement Project RED initiatives elsewhere in the country to expand the research project. Meaning it may not be long before a virtual discharge assistant is helping out with patients at your organization.

Read about Project RED and meet Louise.

Rebecca Hendren is a senior managing editor at HCPro, Inc. in Danvers, MA. She edits and manages The Leaders' Lounge blog for nurse managers. Email her at

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