The Impact of Revised Discharge Instructions on Patient Satisfaction.
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ABSTRACT: Introduction
The impact of discharge instructions on a patient's experience is not fully understood. This research explored whether nurse- and physician-generated discharge instructions had a positive effect on patient perceptions regarding their discharge experience.Methods
We compared Press Ganey discharge-related patient satisfaction scores for the year prior to and the year subsequent to implementing revised discharge instructions for all patients admitted to a 180-bed community-based hospital.Results
Following the implementation of our revised discharge instructions, patient satisfaction significantly improved (84.7% vs 83%, P < .01). Patients responded that they felt ready for discharge (86.6% vs 84.9%, P = .01) and were satisfied with instructions for home care (87.8% vs 85.3%, P < .01).Discussion
This study finds that a novel discharge instruction set produced by both the nursing and physician staff may improve patient perceptions with the discharge process.
SUBMITTER: Waniga HM
PROVIDER: S-EPMC5513645 | biostudies-literature | 2016 Sep
REPOSITORIES: biostudies-literature
Publications
The Impact of Revised Discharge Instructions on Patient Satisfaction.
Waniga Heather Markey HM Gerke Travis T Shoemaker Alena A Bourgoine Derek D Eamranond Pracha P
Journal of patient experience 20160901 3
<h4>Introduction</h4>The impact of discharge instructions on a patient's experience is not fully understood. This research explored whether nurse- and physician-generated discharge instructions had a positive effect on patient perceptions regarding their discharge experience.<h4>Methods</h4>We compared Press Ganey discharge-related patient satisfaction scores for the year prior to and the year subsequent to implementing revised discharge instructions for all patients admitted to a 180-bed commun ...[more]
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Project description:BACKGROUND:Previous studies have demonstrated that patients have poor understanding of the discharge instructions provided from the emergency department (ED). The aims of this study are to determine if patient factors, such as income and level of education, correlate with patient understanding of discharge instructions and to explore if different patient populations prefer different resources for receiving discharge instructions. METHODS:We conducted live observations of physicians providing discharge instructions in the ED to 100 patients followed by a patient survey to determine their understanding in four domains (diagnosis, treatment plan, follow-up instructions, and return to ED (RTED) instructions) and collect patient demographics. We enrolled patients over the age of 18 being discharged home. We excluded non-English- or French-speaking patients and those with significant psychiatric history or cognitive impairment. We performed a two-way ANOVA analysis of patient factors and patient understanding. RESULTS:We found that patients had poor understanding of discharge instructions, ranging from 24.0% having poor understanding of their follow-up plan to 64.0% for RTED instructions. Almost half (42%) of patients did not receive complete discharge instructions. Lower income was correlated with a significant decrease in patient understanding of discharge diagnosis (p?=?0.01) and RTED instructions (p?=?0.04). Patients who did not complete high school trended towards lower levels of understanding of their diagnosis and treatment plan (p?=?0.06). Lower income patients had a preference for receiving a follow-up phone call by a nurse, while higher income patients preferred online resources. CONCLUSIONS:Lower income patients and those who have not completed high school are at a higher risk of poor understanding discharge instructions. As new technological solutions emerge to aid patient understanding of discharge instructions, our study suggests they may not aid those who are at the highest risk of failing to understand their instructions.
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Project description: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.
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Project description:ContextParents often manage complex instructions when their children are discharged from the inpatient setting or emergency department (ED); misunderstanding instructions can put children at risk for adverse outcomes. Parents' ability to manage discharge instructions has not been examined before in a systematic review.ObjectiveTo perform a systematic review of the literature related to parental management (knowledge and execution) of inpatient and ED discharge instructions.Data sourcesWe consulted PubMed/Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, and Cochrane CENTRAL (from database inception to January 1, 2017).Study selectionWe selected experimental or observational studies in the inpatient or ED settings in which parental knowledge or execution of discharge instructions were evaluated.Data extractionTwo authors independently screened potential studies for inclusion and extracted data from eligible articles by using a structured form.ResultsSixty-four studies met inclusion criteria; most (n = 48) were ED studies. Medication dosing and adherence errors were common; knowledge of medication side effects was understudied (n = 1). Parents frequently missed follow-up appointments and misunderstood return precaution instructions. Few researchers conducted studies that assessed management of instructions related to diagnosis (n = 3), restrictions (n = 2), or equipment (n = 1). Complex discharge plans (eg, multiple medicines or appointments), limited English proficiency, and public or no insurance were associated with errors. Few researchers conducted studies that evaluated the role of parent health literacy (ED, n = 5; inpatient, n = 0).LimitationsThe studies were primarily observational in nature.ConclusionsParents frequently make errors related to knowledge and execution of inpatient and ED discharge instructions. Researchers in the future should assess parental management of instructions for domains that are less well studied and focus on the design of interventions to improve discharge plan management.
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