Purpose: The purpose of this study was to assess the level of knowledge, and to identify the self-perceived key components, of the plan of care reported by hospitalized general medicine patients. Using this information, we developed and tested an intervention to improve patients’ knowledge of their plan of care.
Description: To assess the self-reported level of knowledge of the plan of care of hospitalized patients, observations of 45 patient interactions on general medicine teams were completed over a 2-week period. During these observations, patients were interviewed within 2 hours of the medical team’s bedside rounds, using a questionnaire that utilized a 5-point Likert scale with “very good” as the highest level. Of patients interviewed (n=30), 45% rated their knowledge of the plan of care for the day as “very good”. When asked the components of the plan of care that they did not know, expected discharge (34%), medication changes (11%), and tests planned for the day (5%) were listed as the main areas of uncertainty. We utilized this information to develop a mnemonic that incorporated the key components of the plan of care identified by patients, C.A.R.E.: Consults, Assessments (Tests or Procedures), Rx Changes (Medications), and Expected Discharge information. We then tested an intervention in which hospitalists utilized C.A.R.E. to communicate the plan of care to patients, both verbally and to be written on the whiteboard in each patient’s room, using a pre-test/post-test design. Hospitalists’ compliance with the intervention was monitored by observing for documentation of the C.A.R.E. plan of care on the whiteboards for patients during the post-period. After implementing our intervention, of patient’s interviewed (n=63), 81% rated their knowledge of the plan of care for the day as “very good” (p=<0.005). With each cycle of testing, the percentage of patients rating their knowledge of the plan of care for the day as “very good” increased. During the last cycle, 100% of patients interviewed rated their knowledge as “very good” (Figure 1).
Conclusions: In this study, the majority of hospitalized patients reported an unsatisfactory level of knowledge of their plan of care for the day at baseline. The utilization of a mnemonic highlighting key components of the plan of care, and documentation on each patient’s whiteboard, was associated with a significant increase in patients’ self-reported assessment of their knowledge of the plan of care.