Project RED Discharge Checklist: A Family Caregiver's Guide

What Project RED Actually Is

Project RED — Re-Engineered Discharge — is a clinical program developed at Boston University Medical Center with funding from the Agency for Healthcare Research and Quality (AHRQ). In randomized controlled trials, it reduced 30-day readmissions by approximately 25%. That result comes from restructuring every step of the discharge process around a single principle: the patient (or their caregiver) must leave the hospital with a complete, written, personally reviewed care plan and a confirmed follow-up call within 72 hours.

The hospital side of Project RED involves twelve components executed by a "discharge advocate" — a nurse or trained staff member who sits with the patient before discharge and works through every item. The problem for families is that most hospitals have adopted parts of Project RED, not all of it. Your parent's hospital may do a medication review but skip the follow-up call. They may hand over a printed discharge summary but never confirm that the primary care physician received it.

That gap between the protocol and what actually happens is where family caregivers step in.

The 12 Components, Translated for Families

Project RED's twelve components were designed for hospital staff, but each one maps directly to something you can verify or do yourself.

1. Educate about the diagnosis. Before your parent leaves, make sure you can explain their primary diagnosis in plain language. If you can't, ask the nurse or doctor to explain it again. Use the teach-back method: "So what I'm hearing is that the fluid around Dad's heart built up because his medication dose was too low — is that right?"

2. Reconcile medications. This is the single highest-impact step. Gather every medication your parent was taking before admission. Compare that list against the new discharge prescriptions. Look for drugs that were stopped, doses that changed, and new additions. If anything is unclear, ask the hospital pharmacist — not the floor nurse — to walk through the differences with you.

3. Confirm follow-up appointments. Don't leave with "follow up with your doctor in a week." Leave with a specific date, time, and clinic address. If the hospital hasn't scheduled it, call the PCP's office from the hospital room before discharge.

4. Understand pending tests and labs. Ask directly: "Are there any test results that haven't come back yet?" If yes, find out who is responsible for reviewing them and how you'll be notified. Write down the test name, expected return date, and the physician who ordered it.

5. Identify red-flag symptoms. For each diagnosis, get a specific list of symptoms that should trigger a phone call to the doctor versus a trip to the emergency department. "Call if things get worse" is not actionable. "Call if weight increases by more than 2 pounds in 24 hours" is.

6. Review the discharge summary. Read the actual document, not just the patient-friendly handout. Look for the medication list, activity restrictions, diet changes, and wound care instructions. If anything contradicts what the doctor told you verbally, get clarification before leaving.

7. Confirm insurance coverage for equipment and services. If your parent needs a walker, commode, or home health visits, verify that these have been ordered and that Medicare or the applicable insurer will cover them. Under Medicare Part B, durable medical equipment is covered at 80% of the Medicare-approved amount when prescribed as medically necessary and sourced from a Medicare-certified supplier.

8. Arrange transportation. This seems basic, but Project RED includes it so the patient can get home safely and the transport plan matches their mobility needs.

9. Ensure the discharge plan matches the home environment. If the plan says "walk 50 feet twice daily" but the living space has stairs your parent can't climb, the plan doesn't work. Flag environmental barriers before discharge so the physical therapist can adjust recommendations.

10. Assess caregiver readiness. The hospital should evaluate whether you — the person taking the patient home — know how to perform wound care, administer injections, or manage oxygen equipment. If they haven't asked, tell them what you're uncertain about.

11. Create the After Hospital Care Plan (AHCP). This is Project RED's key innovation: a single written document that consolidates everything — diagnosis, medications, appointments, symptoms to watch, contact numbers, and activity guidelines — into one reference. You should walk out with this document in hand.

12. Conduct the follow-up phone call. Within 72 hours of discharge, someone should call to verify that medications are being taken correctly, the follow-up appointment is confirmed, and no new symptoms have appeared. If the hospital doesn't call, do this yourself with your parent and use it as a structured medication audit.

Building Your Own 30-Day Prevention Plan

Project RED's 72-hour call is the launchpad, not the finish line. The highest-risk window extends through the first 30 days, and the evidence-based structure for that full period draws from both Project RED and the Coleman Care Transitions Intervention.

Days 1–3: Execute the 72-hour call protocol. Verify every medication is filled and being taken on schedule. Confirm the follow-up appointment. Check that durable medical equipment has arrived and is set up correctly.

Days 4–7: Establish a daily monitoring routine — weight, blood pressure, temperature, and a brief cognitive check (can your parent tell you what day it is and name the month?). Look for early signs of post-hospital syndrome: confusion that wasn't present at discharge, increased fall risk, or appetite loss.

Days 8–14: Attend the first primary care follow-up. Bring the discharge summary, your medication list, and your daily vital sign log. Use this visit to reconcile any remaining medication questions and confirm that pending lab results have been reviewed.

Days 15–30: Gradually reduce direct oversight as your parent's baseline stabilizes, but maintain the daily vital sign log. The risk window continues through day 30, so do not stop monitoring solely because the first two weeks went well.

The Preventing Hospital Readmissions toolkit includes pre-built vital sign logs, a medication reconciliation worksheet modeled on Project RED's After Hospital Care Plan, and a symptom traffic-light card that maps specific clinical thresholds to specific actions — the structured system that makes these 30 days manageable.