NURS FPX 8045 Assessment 6 Synthesis of the Evidence: Substantiating an Intervention for Obesity

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Capella university

NURS-FPX 8045 Doctoral Writing and Professional Practice

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Date

 

Synthesis of Evidence Substantiating an Intervention

A gap in practice exists at We Level Up Treatment Lawrenceville regarding communication and collaboration between nursing staff and patient care workers during patient discharge. Lack of effective discharge processes has resulted in fragmented follow-up care, increasing the likelihood of patient relapses and hospital readmissions, particularly for individuals with Substance Use Disorder (SUD). Fragmented care transitions, inconsistent discharge protocols, and inadequate follow-up communication have been identified as key factors contributing to poor patient outcomes (Mitchell et al., 2022). Strengthening communication and ensuring consistent collaboration between nurses and outpatient providers are crucial for improving care continuity and reducing readmissions.

Agency for Healthcare Research and Quality (AHRQ)’s Re-Engineered Discharge (RED) Toolkit was selected as the intervention to address this gap. Evidence-based RED toolkit provides a structured framework for discharge, patient teaching, and post-discharge follow-up (AHRQ, 2023). By using the RED Toolkit, nurses can deliver clearer communication to patients and ensure follow-up care is coordinated with outpatient providers, reducing the risk of relapse and hospital readmissions (Paolini et al., 2022). Here is the revised PICOT question: 

In nurses working in a drug and alcohol treatment facility (P), how does the implementation of the AHRQ’s RED Toolkit (I), compared to current discharge practices (C), affect hospital readmissions (O) over twelve weeks (T)? 

Chosen Scholarly Articles

Addressing the gap in communication and collaboration during patient discharge at We Level Up Treatment Lawrenceville, RED Toolkit will be implemented. A review of 40 charts has provided insights into the current discharge processes and identified areas for improvement. Du et al. (2021), focused on the adaptation of the RED Toolkit for surgery, demonstrating that “95% of participants reported positive or satisfactory care transitions” following the implementation of structured discharge protocols and follow-up care plans.

According to Mitchell et al. (2022), “implementation of care transition support through the RED intervention can impact collaboration between care teams, especially for patients with depressive symptoms, highlighting the potential for tailored discharge strategies to enhance patient outcomes.” According to Popejoy et al. (2021), “RED program has shown promise in improving communication among healthcare providers in skilled nursing facilities, emphasizing that effective implementation is crucial for achieving optimal outcomes”, which aligns with the goals of applying the RED toolkit at We Level Up Treatment Lawrenceville to enhance care transitions and improve collaborative practices.

NURS FPX 8045 Assessment 6 Synthesis of the Evidence: Substantiating an Intervention for Obesity

According to Paolini et al. (2022), “restructured discharge protocol not only reduced 30-day hospital readmission rates but also fostered effective communication between healthcare professionals and patients,” highlighting the possible benefits of applying the RED Toolkit at We Level Up Treatment Lawrenceville to enhance care coordination and improve communication.

According to Arredondo et al. (2024), “nursing leadership plays a crucial role in implementing the RED, leading to enhancements in discharge processes and communication among healthcare teams,” which aligns with the goals of our intervention at We Level Up Treatment Lawrenceville to improve care transitions and reduce inconsistencies in communication. Findings suggest that the effective application of the RED Toolkit can improve communication and collaboration, thereby addressing the practice gap and reducing the relapse at We Level Up Treatment Lawrenceville.

Critical Review of Chosen Studies

In order to improve care transitions and decrease readmissions at We Level Up Treatment Lawrenceville, the RED Toolkit will be implemented. Five peer-reviewed articles have been reviewed to support RED Toolkit intervention. For the assessment of the articles below, the Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) model will be adopted, which will provide a structured approach to the evaluation of the research methodologies and findings. 

Study by Du et al. (2021), adapted the RED Toolkit to address gaps in communication and collaboration during discharge in colorectal surgery patients. Research intended to assess the implementation and feasibility of the adapted intervention within a regional Veterans Affairs tertiary care center. A patient survey was used to assess healthcare experiences post-discharge. Theoretical basis was the RED Toolkit framework, focusing on improving communication and collaboration through structured discharge processes. According to the JHNEBP model, this study could be rated as Level III due to its quasi-experimental design. Findings showed an improvement in care transitions, with 95% of patients reporting satisfactory outcomes. Du et al., (2021)’s study is applicable to my project by supporting the feasibility of RED interventions in improving communication and collaboration, which aligns with addressing the practice gap at We Level Up Treatment Lawrenceville by enhancing discharge protocols for SUD patients.

NURS FPX 8045 Assessment 6 Synthesis of the Evidence: Substantiating an Intervention for Obesity

Mitchell et al. (2022), investigated whether post-discharge depression treatment coupled with care transition support can improve communication between care teams and reduce errors in discharge plans among patients exhibiting depressive symptoms. A randomized controlled trial methodology involving 709 hospitalized patients with a Patient Health Questionnaire-9 score of 10 or higher is utilized. Primary aim focuses on comparing the outcomes of patients receiving the RED intervention alone versus those receiving the RED intervention combined with additional depression treatment (RED-D). JHNEBP is applied for critical appraisal, revealing strengths such as a robust sample size and a well-defined intervention protocol.

Findings suggest that while care transition support can improve collaboration between teams managing depressive symptoms, improvements in communication were only observed in participants who engaged with the RED-D intervention extensively. Insights from Mitchell et al., (2022)’s study could inform future adaptations of the RED toolkit to enhance outcomes for patients with recurring SUDs and mental health issues at We Level Up Treatment Lawrenceville, reducing readmissions.Popejoy et al. (2021), explored the implementation of the RED program in Skilled Nursing Facilities (SNFs) and its impact on improving communication and collaboration during discharge. Study aimed to compare two implementation strategies—Enhanced and Standard—using a pretest-posttest design to analyze utilization outcomes across four Midwestern SNFs.

NURS FPX 8045 Assessment 6 Synthesis of the Evidence: Substantiating an Intervention for Obesity

Utilizing the JHNEBP, the study effectively highlighted the differences in communication between healthcare teams in the two groups, revealing that the Enhanced strategy resulted in better collaboration. Findings indicate that successful RED implementation can enhance communication in SNFs, suggesting that applying a tailored approach for the RED toolkit at We Level Up Treatment Lawrenceville can similarly improve care transitions and collaboration among staff in the discharge process for patients with substance use disorders and will ultimately reduce the readmissions. 

Paolini et al. (2022), examined the effectiveness of the Careggi RED project in standardizing discharge processes and improving communication among healthcare professionals. Study aims to evaluate how the restructured discharge protocol impacts communication between General Practitioners (GPs) and patients and how this enhances discharge practices. A pre–post-survey design was employed, which included 1549 hospitalizations, with data collected from GPs and patients to assess perceived quality and satisfaction.

Theoretical framework is based on the principles of effective communication and care coordination, emphasizing the importance of relationships among healthcare providers in the discharge process. Utilizing the Johns Hopkins evidence appraisal, this study demonstrates a strong methodology with improved communication and collaboration post-intervention, leading to reduced relapse. Strengths of the study include robust sample size and clear outcome measures, while limitations include a lack of randomization and confounding variables. Applying RED Toolkit discharge protocol, could improve care transitions and collaboration at We Level Up Treatment Lawrenceville, emphasizing the need for effective communication among healthcare providers. 

NURS FPX 8045 Assessment 6 Synthesis of the Evidence: Substantiating an Intervention for Obesity

An article by Arredondo et al. (2024) emphasizes the positive impact of nursing leadership on enhancing discharge practices through the application of the RED project. Study primarily aims to evaluate how leadership strategies influence communication and teamwork during the discharge process. Using the JHNEBP Model, the study demonstrates moderate strength in evidence, with identified strengths including a clear focus on nursing leadership and collaborative communication. Limitations include a lack of diversity in the sample population, which can affect generalizability.

Findings suggest that enhanced nursing leadership and adherence to the RED framework can improve communication and collaboration during the discharge process, making it applicable to the We Level Up Treatment Lawrenceville initiative to address care transitions and improve communication. Findings from the above five articles underscore the significance of structured discharge processes and effective communication in enhancing collaboration and patient outcomes. By integrating the above evidence-based strategies into practice, We Level Up Treatment Lawrenceville aims to foster improved teamwork and communication, ultimately enhancing care quality for patients with SUDs and reducing the risk of relapse.

Synthesis of Literature Using MEAL Plan

Application of the RED Toolkit has been found to be a viable approach to improving care transitions and addressing communication gaps in patients with SUDs. Several works emphasize the importance of structured discharge planning and effective collaboration between healthcare professionals and patients. Du et al. (2021), highlighted that using the RED Toolkit in surgical practices improved patient satisfaction and enhanced communication, reducing post-discharge issues. Mitchell et al. (2022), demonstrated that integrating care transition interventions with individualized discharge planning enhances patient outcomes, particularly for those with mental health challenges.

Systematic implementation by Popejoy et al. (2021), and the engagement of general practitioners and patients, as shown by Paolini et al. (2022), revealed that improved communication leads to better care transitions. Arredondo et al. (2024), described how strong nursing leadership in discharge planning amplifies the effectiveness of the RED Toolkit in enhancing team collaboration and patient experiences. Analysis of articles suggests that the RED Toolkit, when paired with strong leadership and clear communication, can improve care coordination. We at We Level Up Treatment Lawrenceville can apply insights to target structured protocols and foster collaborative practices, addressing the existing gaps in communication and reducing the readmissions.

Evaluating the Quality of Evidence

Data gathered from the five articles provides a strong framework for applying the RED Toolkit to address inconsistent communication and collaboration at We Level Up Treatment Lawrenceville. The strengths include diverse study designs, such as randomized controlled trials and quality improvement projects, which enhance the reliability of findings (Arredondo et al., 2024). Du et al. (2021), demonstrated that improving discharge intervention in surgical contexts led to better communication and smoother care transitions, showcasing the toolkit’s adaptability. However, some limitations include the lack of randomization in certain studies and biases (Paolini et al., 2022).

The strength of evidence is moderate, supporting the toolkit’s effectiveness, though further research is needed for its application in populations with substance use disorders and mental health conditions. Other interventions, such as enhanced patient education and structured follow-up, could complement the RED Toolkit. Some limitations include adapting the toolkit for specific patient needs and the long-term effects of the intervention. More research on the role of nursing leadership in fostering communication, as highlighted by Arredondo et al. (2024), would provide insight into improving care transitions. We Level Up Treatment Lawrenceville can enhance care transitions, eventually reducing the risk of relapse, by addressing the gaps in communication and collaboration through the application of the RED Toolkit.

Conclusion

Implementation of the RED Toolkit at We Level Up Treatment Lawrenceville addresses communication and cooperation issues during patient discharge. Main idea is to improve communication during discharge. Data from different sources proves the utility of the RED Toolkit in advancing care transitions. Additional input on staff training and patient needs assessment will enhance the intervention outcomes to increase optimal discharge practice.

References

AHRQ. (2023, April). Re-Engineered Discharge (RED) Toolkit. Www.ahrq.gov. https://www.ahrq.gov/patient-safety/settings/hospital/red/toolkit/index.html 

Arredondo, K., Renfro, D., Naungayan, A., & Renfro, D. (2024). Improving the discharge process at the VA Palo alto through change management and implementation of project re-engineered discharge. PubMed, 49(3), 95–100. https://doi.org/10.1097/rnj.0000000000000461 

Du, R. Y., Shelton, G., Ledet, C. R., Mills, W. L., Neal-Herman, L., Horstman, M., Trautner, B., Awad, S., Berger, D., & Naik, A. D. (2020). Implementation and feasibility of the re-engineered discharge for surgery (RED-S) intervention: A pilot study. Journal for Healthcare Quality, 43(2), 92–100. https://doi.org/10.1097/jhq.0000000000000266 

Mitchell, S. E., Reichert, M., Howard, J. M., Krizman, K., Bragg, A., Huffaker, M., Parker, K., Cawley, M., Roberts, H. W., Sung, Y., Brown, J., Culpepper, L., Cabral, H. J., & Jack, B. W. (2022). Reducing readmission of hospitalized patients with depressive symptoms: A randomized trial. The Annals of Family Medicine, 20(3), 246–254. https://doi.org/10.1370/afm.2801 

NURS FPX 8045 Assessment 6 Synthesis of the Evidence: Substantiating an Intervention for Obesity

Paolini, D., Bonaccorsi, G., Lorini, C., Forni, S., Tanzini, M., Toccafondi, G., D’arienzo, S., Dannaoui, B., Niccolini, F., Tomaiuolo, M., Bussotti, A., Petrioli, A., & Morettini, A. (2022). Careggi re-engineered discharge project: Standardize discharge and improve care coordination between healthcare professionals. International Journal for Quality in Health Care, 34(3). https://doi.org/10.1093/intqhc/mzac060 

Popejoy, L. L., Vogelsmeier, A. A., Wang, Y., Wakefield, B. J., Galambos, C. M., & Mehr, D. R. (2020). Testing re-engineered discharge program implementation strategies in SNFs. Clinical Nursing Research, 30(5), 644–653. https://doi.org/10.1177/1054773820982612

Appendix

Citation	Conceptual Framework	Design/ Method	Sample/Setting	Major Variables Studied and their Definition	Measurement	Data Analysis	Findings	Appraisal: Worth to Practice
(Du et al., 2020)	Re-Engineered Discharge (RED) Toolkit framework	Pilot study	21 patients were admitted for colectomy at a regional VA tertiary care center between July 2014 and January 2015.	1. Wound care education: Teaching patients how to care for surgical wounds. 2. Medication reconciliation: Ensuring patients understand their medications post-discharge. 3. After Hospital Care Plan: A written plan detailing follow-up care. 4. Post-discharge phone calls: Follow-up communication to address patient concerns.	Survey of Healthcare Experiences of Patients (SHEP) and adherence to intervention components.	Descriptive statistics were used to analyze survey responses and intervention adherence.	95% of participants reported positive or satisfactory care transitions, higher than a comparison group (less than 60%). Half received pharmacist-led medication reconciliation, and 75% received a post-discharge phone call.	Strengths: The study demonstrates high participant satisfaction and adherence to intervention components, indicating its effectiveness. Limitations: Small sample size and short follow-up duration may limit generalizability. Level: Evidence Level II Reliability: Yes Applicability: Yes Overall Rank: B
(Mitchell et al., 2022)	Care transition support and cognitive-behavioral therapy	Randomized controlled trial	709 hospitalized patients with depressive symptoms from a healthcare facility	Primary variables include: 1) Hospital readmission rates—measured as the percentage of patients readmitted within 30 and 90 days post-discharge; 2) Reutilization rates—measured as the number of hospital visits within the same time frame; 3) RED-D intervention adherence—number of sessions attended by participants.	Patient Health Questionnaire-9 (PHQ-9) for depressive symptoms, tracking of hospital readmissions and reutilization rates	Intention-to-treat and as-treated analyses were conducted to assess outcomes.	No differences in reutilization rates between RED and RED-D groups at 30 and 90 days. However, increased engagement with RED-D sessions correlated with enhanced communication leading to reduced readmissions.	Strengths include a large sample size and comprehensive intervention design; limitations consist of the lack of differences between groups, indicating a need for more tailored approaches. Level of evidence is moderate; findings suggest applicability in enhancing mental health support during care transitions. Overall rank is High.
(Popejoy et al., 2020)	Implementation Science	Pretest-posttest design	Four Midwestern skilled nursing facilities (SNFs)	Rehospitalization rates defined as the percentage of patients readmitted to the hospital within 30, 60, and 180 days post-discharge	Adjusted rehospitalization rates before and after intervention	Poisson regression analysis to compare outcomes	The Enhanced RED strategy showed lower rehospitalization rates compared to the Standard group, with reductions at 30, 60, and 180 days	Strengths include a clear focus on communication strategies and use of rigorous statistical methods. Limitations involve the small sample size and specific regional focus.  Ranking: Level moderate Validity: yes Reliability: yes Applicability: Yes Overall rank: High
(Paolini et al., 2022)	Effective Communication and Care Coordination	Pre–Post Survey Design	1549 hospitalizations across four Italian hospitals	30-day Hospital Readmission Rate: The percentage of patients readmitted to the hospital within 30 days post-discharge. GP Perceived Quality: GPs’ assessment of the discharge letter and communication effectiveness.	Discharge letters and satisfaction surveys completed by GPs and patients	Chi-square tests for categorical variables	The 30-day readmission rate decreased from 19.4% to 14.4% after implementing CaRED (p < 0.05). GPs reported improved communication and understanding of discharge instructions.	The study provides strong evidence supporting the effectiveness of structured discharge protocols like CaRED. Its findings are applicable to enhancing communication and reducing readmissions at We Level Up Treatment Lawrenceville. Strengths include a large sample size and results, while limitations involve a non-randomized design. Overall, the study ranks as a Level II evidence for practice.
(Arredondo et al., 2024)	Change management principles and nursing leadership	Quality improvement project with pre- and post-implementation assessment	No sample and setting specified	Nursing leadership and discharge outcomes: Nursing leadership refers to the ability to influence and guide teams in improving patient discharge processes, while discharge outcomes encompass metrics related to successful patient transitions from hospital to home.	Assessments of discharge practices and patient satisfaction scores	Comparative analysis of pre- and post-implementation data	Enhanced nursing leadership positively impacted discharge processes and improved patient outcomes.	Moderate strength in evidence according to the Johns Hopkins model; strengths include a focus on leadership in nursing, while limitations involve a lack of diversity in the sample, affecting generalizability; overall, findings are applicable for improving discharge processes in similar settings.