Improving the Readability of Pediatric Hospital Medicine

Abstract

Use of standardized discharge instruction templates and rapid feedback to staff improved the readability of instructions. Next steps include adaptation and spread to other patient populations.

A Scoping Review on How to Make Hospitals Health Literate Healthcare Organizations

“…Very few studies [50,64,67,68,76,110] have explored the effect of environmental support on health professionals, and few outcomes related to staff satisfaction/perception of helpfulness have been reported [23,[100][101][102][103][104]. At the same time, studies examining interventions to support the governance of the organization, despite receiving more attention, often had methodological limitations, due to their weak study designs.…”

A STEEEP Hill to Climb: A Scoping Review of Assessments of Individual Hospitalist Performance

“…Studies coded to the Patient Centered domain assessed hospitalist performance through ratings of patient satisfaction, 8,9,[41][42][43][44] rating of communication between hospitalists and patients, [19][20][21]29,[45][46][47][48][49][50][51] identification of patient preferences, 38,52 outcomes of patient-centered care activities, 27,28 and peer ratings. 53,54 Authors applied several theoretical constructs to these assessments including shared decision-making, 50 etiquette-based medicine, 47,48 empathetic responsiveness, 45 agreement about the goals of care between the patient and healthcare team members, 52 and lapses in professionalism.…”

“…53 Studies often crossed STEEEP domains, such as those assessing quality of discharge information provided to patients, which were coded as both Safe and Patient Centered. [19][20][21] In addition to coded or observed performance in the clinical setting, studies in this domain also used patient ratings as a method of assessment. 8,9,28,[41][42][43][44]49,50 Only a few of these approaches aligned with existing performance measures of health systems and were more automated.…”

“…Sign-out for cross-covering providers Survey of cross-covering provider on sign-out adequacy for patient inquiries 15 Iterative scoring of sign-outs on 13 desired elements 16 Handoffs to new primary provider 18-item survey of new primary provider within 48 hours of assuming care 17 Discharge summaries Scoring via a 13-element checklist 18 Scoring for required and recommended elements, as well as readability [19][20][21] Scoring heart failure patients on 29 elements important for heart failure care 23 PCP awareness of hospitalization Single-question survey faxed to PCP at 2 weeks after discharge 24,25 Interrogation of phone records for a call to PCP's office during hospitalization 22 Resolution of discharge barriers 12-item checklist of barriers completed daily by patients 28 Medication changes across transitions of care Comparison of EHR medication list at admission and discharge with medication list 3 days after discharge per phone call with patient 27 Adverse events after discharge Structured phone interview with patient 2 weeks after discharge 24 Reasons for SNF readmission Interviews with SNF clinicians about specific readmitted patients 26 Unprofessional behavior 35-item survey of self and peers that included behaviors that may hinder safety 53 Timely (n =11) Time spent on various activities Observation by trained observers of work process 30,31 Admission ID of care goals Coded admission encounters in seriously ill patients 29 Evidence/guideline application Evaluation of performance in simulated cases: COPD and sepsis 32 PCP awareness of hospitalization Single-question survey faxed to PCP at 2 weeks after discharge 24,25 Interrogation of phone records for a call to PCP's office during hospitalization 22 Discharge summaries Verification of completion relative to date of discharge and determination of whether it was sent to outside practitioner 18 Reasons for SNF readmission Interviews with SNF clinicians about specific readmitted patients 26 Multidimensional dashboard of individual/group performance Collation of system metrics such as early discharge orders, 9 length of stay, 8,9 timing of follow-up 8…”

Preparing From the Outside Looking In for Safely Transitioning Pediatric Inpatients to Home

“…Physicians and health systems should explore approaches to better prepare caregivers, perhaps using models akin to the Seamless Transitions and (Re)admissions Network model of enhanced communication, care coordination, and family engagement. 10 Pediatric hospitalists can prepare children for discharge long before departure by delivering medications to patients prior to discharge, 11,12 providing discharge instructions that are clear and readable, 13,14 as well as utilizing admission-discharge teaching nurses, 15 inpatient care managers, 16,17 and pediatric nurse practitioners 18 to aid transition.…”