Understanding Of Discharge Instructions Research Articles

Client's understanding of instructions for small animals in a veterinary neurological referral center.

It is not known how much information clients retrieve from discharge instructions. To investigate client's understanding of discharge instructions and influencing factors. Dogs and cats being hospitalized for neurological diseases. Clients were presented questionnaires regarding their pet's disease, diagnostics, treatments, prognosis and discharge instructions at time of discharge and 2 weeks later. The same questions were answered by discharging veterinarians at time of discharge. Clients answered additional questions regarding the subjective feelings during discharge conversation. Data collected included: data describing discharging veterinarian (age, gender, years of clinical experience, specialist status), data describing the client (age, gender, educational status). Raw percentage of agreement (RPA) between answers of clinicians and clients as well as factors potentially influencing the RPA were evaluated. Of 230 clients being approached 151 (65.7%) and 70 (30.4%) clients responded to the first and second questionnaire, respectively (130 dog and 30 cat owners). The general RPA between clinician's and client's responses over all questions together was 68.9% and 66.8% at the 2 time points. Questions regarding adverse effects of medication (29.0%), residual clinical signs (35.8%), and confinement instructions (36.8%) had the lowest RPAs at the first time point. The age of clients (P = .008) negatively influenced RPAs, with clients older than 50 years having lower RPA. Clients can only partially reproduce information provided at discharge. Only clients' increasing age influenced recall of information. Instructions deemed to be important should be specifically stressed during discharge.

Implementing teach-back during patient discharge education.

To determine how registered nurses understood the teach-back method and whether such understanding translated to better evaluation of patients' understanding of discharge instructions. The teach-back method helps nurses confirm whether the information provided to patients is understood. The current literature indicates the benefits of teach-back; however, nurses do not apply the method adequately during discharge teaching. This study used a qualitative pretest-posttest design with an educational session. A consecutive sampling method was used. Twelve nurses were interviewed using a discussion guide to gauge their understanding of the teach-back method during the period July to August 2016. This was followed by an educational session on the teach-back method. Nurses then implemented the method on the medical/surgical unit. A second interview was conducted using a questionnaire to evaluate participants' understanding of the method. Data were analyzed using Atlas.ti 7 software. Participants' knowledge of the teach-back method increased. Participants identified benefits associated with the method, but time constraint was a concern. The findings contribute to an understanding of the teach-back method by nurses. Patient care will benefit if the method is reinforced among nurses through continuing in-service education.

Evaluation of discharge instructions among hospitalized Lebanese patients.

Background:Hospital readmissions are considered as the primary indicator of insufficient quality of care and are responsible of increasing annual medical costs by billions of dollars. Different factors tend to reduce readmissions, particularly instructions at discharge.Objectives:Our study objective was to evaluate discharge instructions given to hospitalized Lebanese patients and associated factors.Methods:Two hundred patients, aged between 21 and 79 years and admitted to the emergency department, were recruited from a Lebanese university hospital. Discharge instructions were evaluated by a face-to-face interview to fill a questionnaire with the patients immediately after their final contact with the physician or nurse in charge. We mainly focused on medications instructions and created two scores related to “instructions given” and “instructions appropriate” to later conduct bivariate analysis.Results:We found that discharge instructions were not completely given to all our study population. The degree of appropriateness fluctuated between 25% and 100%. The instructor in charge of giving discharge instructions had its significant influence on medication instructions given (p=0.014). In addition, the instructor and his experience influenced the degree of “appropriate instructions”. In fact, our study showed that despite being capable of giving good medication advice, nurses’ instructions were significantly less effective in comparison with physicians, fellows and residents. However, nurses gave 52% of the instructions, which questions the quality of those instructions.Conclusions:In conclusion, our observational study showed that in a Lebanese university hospital, patients’ understanding of discharge instructions is poor. Careful attention should be drawn to other hospitals as well and interventions should be considered to improve instructions quality and limit later complications and readmissions. The intervention of clinical pharmacists and their medication-related advice might be crucial in order to improve instructions’ quality.

Teach-Back Method: Using a Nursing Education Intervention to Improve Discharge Instructions on an Adult Oncology Unit.

Transitions from acute clinical care to the outpatient setting can be daunting. Clear explanations of discharge instructions from nurses and assessment of the patient's understanding can have a positive impact. The purpose of this study was to assess the effect of an education intervention on nurses' use of the teach-back method, as well as the effects on patient satisfaction at discharge. The setting was a 20-bed adult oncology unit. Nurses' understanding of the teach-back method pre- and posteducation intervention was assessed using the Conviction and Confidence Scale. The effect of the intervention on patient satisfaction was assessed using the Press Ganey survey three months before and after teach-back education. The results of this study indicated that nurses were more confident in their ability to use the teach-back method and integrated many teach-back competencies into clinical practice. Although few follow-up surveys were received, longer-term data indicated continued improvement in patient satisfaction and understanding of discharge instructions.

423 Identifying Burn Patient Challenges with Implementation of Follow-Up Phone calls

After hospitalization, some burn patients find the transition to the outpatient setting to be challenging. Patients are sometimes overwhelmed by discharge instructions and can miss many important details. As a result, some patients have experienced graft failure or infection due to poor wound care, ineffective pain control, or inadequate out-patient services. We have implemented follow-up phone calls to all discharged patients to attempt to improve patient outcomes. The pilot study of follow-up phone calls ran for four months. During this time, every patient seen or discharged from the Burn Center received a phone call from the assistant nurse manager within a week of discharge. Topics for the phone call included: general well-being, dressing changes, understanding of discharge instructions, medication, ancillary services including skilled nursing and occupational and physical therapy, and assistance with follow-up appointments. The need for and type of intervention subsequently undertaken was recorded. Fifty-two patients were included in this study, 21 (40%) of whom required intervention. Six (11.5%) had VNA that did not arrive or VNA nurses who were uncomfortable caring for the patient’s wounds. Nine (17.3%) needed interventions with either dressings or prescribed medications. Ten (19.2%) had either expedited wound center visits or new appointments made due to pain or infection risk. Despite detailed written discharge instructions and verbal review of those instructions prior to discharge, patients often require further assistance to obtain optimal care when they leave the hospital. By implementing routine follow-up telephone calls with discharged patients, we were able to identify patients requiring assistance. These included issues such as making post-discharge appointments, arrangements for services (skilled nursing visits; occupational and physical therapy), and the need for medication adjustment. This intervention also assisted with early detection of patients who had difficulty with dressing changes and showed signs of infection or graft failure, and expedited follow-up care in the outpatient setting. We conclude that the follow-up phone calls helped to identify and address challenges that arise for a significant number (40%) of patients and families when being discharged to home. Continuing research will determine if follow-up phone calls help prevent readmission rate and infection rates post-burn. Early identification of potential issues that may complicate the patient’s both short and long term outcome. Evaluating the relevance of patient challenges will improve patient outcomes.

Evaluating the Use of Teach-Back in Simulation Training to Improve Discharge Communication Practices of Undergraduate Nursing Students

BackgroundThis study evaluates the effectiveness of information- and interaction-based training interventions to improve nurses' communication skills during the discharge of a patient. MethodA quasi-experimental control group design was applied. Students demonstrated their discharge skills with simulated patients (SPs) in three randomly assigned groups namely control, information-, and interaction-based intervention. An independent group multivariate analyses of variance was used for analysis of both the quality of discharge content and delivery across groups using student, SP, and faculty assessor ratings. ResultsSignificant incremental improvements in student communication skills were achieved in the interaction and information groups compared with the control group. ConclusionA structured curriculum including high-fidelity simulation, with SPs providing feedback and evaluating students' information- and interaction-based communication skills, is useful in improving student discharge practices and “patients'” understanding of discharge instructions.

Abstract NS7: Driving Down Readmissions With Dynamic Discharge Follow up Team

Introduction: Stroke patients have complex discharge needs and benefit from strong care transition models. A common care transition model is to perform discharge phone calls to eliminate gaps that may have occurred after discharge. Institutions often struggle with performing discharge phone calls - who should perform this task and what the optimal timeframe should be. Ninety percent of this institution’s 30-day readmissions occur within the first 7 days of hospital discharge, with majority due to medication misunderstanding and poor communication. Hospital readmissions have negative consequences for patients and are costly, accounting for $15 billion of Medicare dollars annually. Methods: In 2014, stroke discharges to home received a 48 hour phone call from an outpatient Registered Nurse (RN) Care Manager. In 2015, to address the medication challenges, a Pharmacist was added to the discharge follow-up team, making phone calls within 7 days of discharge. Results: In 2016, 233(61%) of the 48-hour calls by RNs connected successfully with stroke patients discharged to home. Pharmacist calls reached a higher percentage of patients discharged to home at 83% (n=321). There were 53% (n=208) receiving both calls, and 25% (n=97) of patients being unable to reach after three attempts. The resultant 30-day readmission rate has declined from 8-10% in 2013 and 2014 (when we first started tracking 30-day readmission rates) to 2-3% in 2015. This low rate has remained consistent for 2016 and 2017. Conclusion: Although post-discharge calls can be very labor intensive and time consuming, it is possible to clarify communication, ensure understanding of discharge instructions, and intervene before medication errors occur. The unique combination of an RN and Pharmacist performing the discharge phone calls has been shown to be quite effective; the RN triages acute issues, while the Pharmacist ensures accurate medication list and compliance - and ensures no medication changes were inadvertently made at a primary care provider appointment post-discharge. These interventions reduce readmissions by closing the post-discharge gaps in care that can occur, resulting in a win for both the patient and the institution.

Impact of Discharge Anticoagulation Education by Emergency Department Pharmacists at a Tertiary Academic Medical Center

BackgroundAlthough pharmacists commonly provide patient education and help manage high-risk anticoagulant medications in inpatient and outpatient settings, the evidence for these interventions in the emergency department (ED) is less established, especially in the era of direct-acting oral anticoagulants. In 2013, a formal program was initiated whereby patients discharged with a new prescription for any anticoagulant receive education from an ED pharmacist when on-site. In addition, they received follow-up phone calls from an ED pharmacist within 72 hours of discharge. ObjectiveWe sought to identify the impact of pharmacist education, defined as the need for intervention on callback, versus physician and nursing-driven discharge measures on patient understanding and appropriate use of anticoagulant medications. MethodsA single-center retrospective analysis included patients discharged from the ED between May 2013 and May 2016 with a new anticoagulant prescription. Electronic callback records were reviewed to assess patients' adherence and understanding of discharge instructions as well as for an anticoagulant-related hospital readmission within 90 days. ResultsOne hundred seventy-four patients were evaluated in a per protocol analysis. Patients who did not receive pharmacist education prior to discharge required an increased need for intervention during callback versus those who did (36.4% vs. 12.9%, p = 0.0005) related to adherence, inappropriate administration, and continued use of interacting medications or supplements, among other concerns. In addition, patients who had not received pharmacist counseling were more likely to be readmitted to a hospital or return to the ED within 90 days after their initial visit for an anticoagulation-related problem versus patients who had (12.12% vs. 1.85%, p = 0.0069). ConclusionDischarge education by ED pharmacists leads to improved patient understanding and appropriate use of anticoagulants.

Standardized Physician-Administered Patient-Centered Discharge Protocol Improves Patients' Comprehension.

Patients are 30% less likely to be readmitted or visit the emergency department if they have a clear understanding of their discharge instructions. A standardized approach to a hospital discharge plan has not been universally implemented, however. Our goal was to increase patients' comprehension of discharge instructions by implementing a standardized patient-centered discharge planning protocol that uses a physician team member to explain these plans. This was a prospective study that included all of the patients discharged from an inpatient medical teaching service in a community-based hospital during the study period. We used two 4-week periods separated by 4 months in which training and practice with the study intervention took place. Patients' understanding of discharge instructions was assessed via a follow-up telephone call from a physician co-investigator within 1 week of each patient's discharge. Differences in patients' understanding between groups were analyzed. A total of 181 patients were enrolled, with 9 lost to follow-up. After implementation of the discharge planning protocol, a statistically significant improvement in patients' understanding was found in study subjects' knowledge of their diagnosis, the adverse effects of their medications, whom to call after discharge, and follow-up appointments. Institution of a standardized patient-centered discharge planning protocol can improve patients' understanding of several key components of their discharge process, which may lead to improved compliance with instructions and outcomes.

Inability of Physicians and Nurses to Predict Patient Satisfaction in the Emergency Department.

IntroductionPatient satisfaction is a commonly assessed dimension of emergency department (ED) care quality. The ability of ED clinicians to estimate patient satisfaction is unknown. We sought to evaluate the ability of emergency medicine resident physicians and nurses to predict patient-reported satisfaction with physician and nursing care, pain levels, and understanding of discharge instructions.MethodsWe studied a convenience sample of 100 patients treated at an urban academic ED. Patients rated satisfaction with nursing care, physician care, pain level at time of disposition and understanding of discharge instructions. Resident physicians and nurses estimated responses for each patient. We compared patient, physician and nursing responses using Cohen’s kappa, weighting the estimates to account for the ordinal responses.ResultsOverall, patients had a high degree of satisfaction with care provided by the nurses and physicians, although this was underestimated by providers. There was poor agreement between physician estimation of patient satisfaction (weighted κ=0.23, standard error: 0.078) and nursing estimates of patient satisfaction (weighted κ=0.11, standard error: 0.043); physician estimation of patient pain (weighted κ=0.43, standard error: 0.082) and nursing estimates (weighted κ=0.39, standard error: 0.081); physician estimates of patient comprehension of discharge instruction (weighted κ=0.19, standard error: 0.082) and nursing estimates (weighted κ=0.13, standard error: 0.078). Providers underestimated pain and patient comprehension of discharge instructions.ConclusionED providers were not able to predict patient satisfaction with nurse or physician care, pain level, or understanding of discharge instructions.

Automated Phone Assessments and Hospital Readmissions.

This analysis examined the efficacy of an automated postdischarge phone assessment for reducing hospital readmissions. All patients discharged between April 1, 2013, and January 31, 2014, from a single Level 1 trauma hospital of a large regional health system center utilizing an automated postdischarge phone assessment service were contacted via automated call between 24 and 72 hours post discharge. Patients answered 5 questions assessing perceived well-being, understanding of discharge instructions and medication regimen, satisfaction, and scheduled follow-up appointments. Responses could automatically prompt health personnel to speak directly with the patient. Data analysis examined rates of hospital readmission-any admission occurring within 30 days of a previous admission-for 3 broad categories of respondents: Answering Machine, Live Answer, and Unsuccessful. There were 6867 discharges included in the analysis. Of the Live Answer patients, 3035 answered all assessment questions; 153 (5.0%) of these had a subsequent readmission. Of the 738 Unsuccessful patients, 62 (8.4%) had a subsequent readmission. Unsuccessful patients were almost 2 times more likely to have a readmission than those who answered all 5 assessment questions. Of the latter group, readmission rates were highest for those who perceived a worsening of their condition (7.4%), and lowest for those reporting no follow-up appointment scheduled (3.8%). (Population Health Management 2016;19:120-124).

Discharge Education Curriculum for Residents Rotating on an Inpatient Pediatric Ward

Abstract The adult literature has demonstrated that patient preferences and understanding of discharge instructions can impact success of discharge and even predict return ER visits. There is very ...

Patient Understanding of Emergency Department Discharge Instructions: Where Are Knowledge Deficits Greatest?

Many patients are discharged from the emergency department (ED) with an incomplete understanding of the information needed to safely care for themselves at home. Patients have demonstrated particular difficulty in understanding post-ED care instructions (including medications, home care, and follow-up). The objective of this study was to further characterize these deficits and identify gaps in knowledge that may place the patient at risk for complications or poor outcomes. This was a prospective cohort, phone interview-based study of 159 adult English-speaking patients within 24 to 36 hours of ED discharge. Patient knowledge was assessed for five diagnoses (ankle sprain, back pain, head injury, kidney stone, and laceration) across the following five domains: diagnosis, medications, home care, follow-up, and return instructions. Knowledge was determined based on the concordance between direct patient recall and diagnosis-specific discharge instructions combined with chart review. Two authors scored each case independently and discussed discrepancies before providing a final score for each domain (no, minimal, partial, or complete comprehension). Descriptive statistics were used for the analyses. The study population was 50% female with a median age of 41 years (interquartile range [IQR] = 29 to 53 years). Knowledge deficits were demonstrated by the majority of patients in the domain of home care instructions (80%) and return instructions (79%). Less frequent deficits were found for the domains of follow-up (39%), medications (22%), and diagnosis (14%). Minimal or no understanding in at least one domain was demonstrated by greater than two-thirds of patients and was found in 40% of cases for home care and 51% for return instructions. These deficits occurred less frequently for domains of follow-up (18%), diagnosis (3%), and medications (3%). Patients demonstrate the most frequent knowledge deficits for home care and return instructions, raising significant concerns for adherence and outcomes.