Background: Transition from the inpatient to outpatient setting presents a safety risk to pediatric patients. Project IMPACT (Improving Pediatric Patient-Centered Care Transitions) is a multi-site quality improvement collaborative developed to improve the hospital to home transition for pediatric patients using a transition bundle. One bundle element is the use of teach-back (TB) to confirm caregiver understanding of the discharge care plan. Initial results from Project IMPACT demonstrated that hospital reutilization is significantly less for patients whose caregivers’ discharge education included TB. However, despite initiatives to increase use of TB, local rates remained below goal. Concern for accuracy of education documentation was raised. The purpose of this study was to determine and compare the accuracy of TB documentation and caregiver perception of TB occurrence.
Methods: Observations and surveys were performed for patients on the hospital medicine service under the age of 18 between 6/2017 and 11/2017. Patients were selected by convenience sampling. Upon verbal consent of the participating nurse, discharge education was observed by one of two study group members using a hospital approved observation tool to assess for communication practices including the use of TB. Immediately following discharge education, upon written consent, the patient’s caregiver participated in a survey targeting perceptions of the discharge education process, including TB use. Following discharge, retrospective chart reviews were performed to determine if TB use was documented by the nurse performing discharge education.
Results: During the study period, 70 discharges were observed. Of the 70 observations, TB occurred 61% of the time and was documented 59% of the time. However, TB observation and documentation did not always correlate. Observation of TB matched documentation of TB 57% of the time. When observation and documentation did not match, TB was done but not documented 47% of the time; TB was documented but not observed 53% of the time. The post-discharge survey was completed by 69 of 70 families; 1 family declined participation. For the 69 participating families, TB observation and perception correlated 77% of the time. When observation and perception did not match, TB was done but not perceived 69% of the time and not done but perceived to be done 31% of the time. When TB occurred, families perceived its use 45% of the time.
Conclusions: Neither documentation nor family perception of TB performance consistently aligned with observed occurrence, but family perception of TB performance was a more accurate predictor. However, caregivers failed to identify the use of TB more than half of the time when it occurred. Further work is needed to identify barriers to accurate nursing documentation and to determine how caregiver perception of TB use is linked to attitudes about education received.