Improving patient understanding on discharge from the short stay unit:an integrated human factors and quality improvement approach

This intervention used a systems approach to improve patient understanding on discharge from the adult acute medicine short stay unit (SSU). Patient understanding was assessed across five domains: diagnosis, medication changes, follow-up care, return instructions and knowing who their consultant was. The aim of this approach was that at least 90% of patients achieved near-complete understanding (score >4) on questionnaire across all five discharge domains by the end of April 2021. Pre-intervention most patients received verbal instructions and only a minority received written information. Through staff interviews, we identified the electronic discharge document (EDD) as a practical source of written information. However, testing with patients showed that the format required substantial redesign to be written in patient-friendly language, using signposting, spacing information out and avoiding jargon. The effect of this intervention was assessed with a structured telephone questionnaire, which included both a patient self-rated score and a comparative understanding score to assess true patient understanding of the revised EDD. Pre-intervention 29 discharged patients were interviewed across 10 days and post-intervention 10 patients were interviewed in 7 days. Patients consistently over-rated their understanding of discharge information. Only one patient achieved the aim of comparative understanding >4 across all domains post-intervention. Understanding improved across all but one of the domains, the exception being medication changes. An important unanticipated consequence was that interviews identified inconsistencies in EDD information and gaps in patient understanding, which required escalation to the SSU team. In summary, this intervention improved patient understanding across four of the five domains. However, further work is required on process reliability for the redesigned EDD and on improving understanding of medication changes. Furthermore, the interviews revealed clinically important inconsistencies in EDD information and gaps in patient understanding

The effect of provider education on discharge information grade level and readability

Problem: The peri-discharge period for patients can be a complex and dangerous time. A large urban academic medical center with a readmission rate approaching 16% utilizes a standardized template called a Discharge Information Form (DIF) to convey information to inpatients at the time of their discharge. The problem is a lack of individualization with a universal template such as the DIF. Moreover, the readability and literacy level of the DIF have not been previously assessed. Methods: A random sample of DIFs was assessed for literacy level using the Flesch-Kincaid Readability Test Tool. An in-person educational intervention was administered to a sample of Hospital Medicine Advanced Practice Providers with the objective of improving their understanding of DIF readability. The providers completed the Continuing Professional Development-Reaction Questionnaire before and after the educational intervention to assess clinical behavioral intentions. One-month post intervention a survey was administered to assess self-reported behavior change, and descriptive statistics were used to look for trends in these data. DIFs were also reassessed for readability, and a paired sample t-test was performed to determine if a change occurred. Findings: After the intervention, statistically significant differences were found in the construct of social influence (p=0.040). Grade level of DIFs was significantly improved (p=0.001), readability of DIFs was nearly significantly improved (p=0.051), and the majority of providers self-reported behavior change. Conclusion: Providers responsible for creating patient discharge information should know how to write literacy level appropriate materials. There is an opportunity to improve discharge information readability through inpatient provider education