Co‐creating patient‐oriented discharge instructions with patients, caregivers, and healthcare providers

Abstract

For hospitalized patients, the transition from hospital to home is frequently accompanied by a significant amount of information to absorb. The objective of this work was to engage patients, caregivers, and healthcare providers in codeveloping patient‐oriented discharge instructions, (ie, a brief transition plan with information that patients want). Overseen by a multidisciplinary advisory team, a participatory action approach using mixed methods was employed. Although formal inclusion and exclusion criteria were not used, deliberate efforts were made to engage groups with language barriers and limited health literacy. Symbols were designed and validated with the patient groups to represent each section of information to make the form more understandable for these patients. A prototype was codesigned using an iterative process. The form has been adapted for use in multiple health settings and is currently undergoing a multisite pilot to evaluate its effect on patient and provider experience. Journal of Hospital Medicine 2015;10:804–807. © 2015 Society of Hospital Medicine

Assessment of Readability, Understandability, and Completeness of Pediatric Hospital Medicine Discharge Instructions

“…15,19 In addition, families may differ in the level of support needed after discharge; standardizing elements and including families in the development of discharge instructions may improve communication. 8 This study had several limitations. First, the discharge instructions randomly selected for review were all written during the winter months.…”

“…Median age was 3.1 years, and median length of stay was 2.0 days. The median readability score corresponded to a 10th-grade reading level (interquartile range, [8][9][10][11][12]; range, 1-13). Median PEMAT score was 73% (interquartile range, 64%-82%; range, 45%-100%); 36% of instructions scored below 70%, correlating with suboptimal understandability.…”

“…4 Evidence supports providing materials written at 6th-grade level or lower to increase comprehension. 7 Several studies have evaluated the quality and readability of discharge instructions for hospitalized adults, 8,9 and one study found a link between poorly written instructions for adult patients and readmission risk. 10 Less is known about readability in pediatrics, in which education may be more important for families of children most commonly hospitalized for acute illness.…”

Patients’ and caregivers’ perspectives on factors that influence understanding of and adherence to hospital discharge instructions: a qualitative study

“…We recruited patients between March and November 2016 who were enrolled in a double-blinded ongoing randomized controlled trial evaluating the influence of an additional discharge instruction tool compared to verbal patient instructions alone conducted at 3 acute care hospitals in Ontario (Toronto Western Hospital, Toronto General Hospital and Thunder Bay Regional Health Sciences Centre). 12,13 Participants had an admission diagnosis of congestive heart failure, chronic obstructive pulmonary disease or pneumonia, 3 quality-based procedures that have at least 1 quality indicator focused on a transitional care need. 11 Patients with cognitive impairment or language barriers could participate through the use of a professional interpreter or family member.…”

Goals of Care or Goals of Life? A qualitative study of clinicians’ and patients’ experiences of hospital discharge using Patient-Oriented Discharge Summaries (PODS)

“…Critical information about medications, monitoring one's health, and when to seek emergency care is often omitted during discharge [1][2][3]. The information that is communicated is often uses language that is beyond the literacy level of the patient or their primary caregiver, further exacerbating their comprehension, fatigue and memory during hospital discharge [4][5][6]. Consequently, patients often leave the hospital with an incomplete understanding of their diagnosis, treatment plan, and expected or concerning symptoms [7].…”