ANTICIPATORY GUIDANCE AND PATIENT SELF-MANAGEMENT AT DISCHARGE: A PROVIDER SURVEY

Background: One of the tools providers use in the discharge process to promote a safe transition of care is the written discharge instructions. Optimization of these instructions has been identified by physicians as a potential strategy to prevent readmissions. Our survey aimed to assess knowledge, attitudes, and self-reported practices of providers related to anticipatory guidance and patient self-management in the discharge process.

Methods: An anonymous web-based survey was sent to hospital-based internal medicine providers at a large academic medical center, which included resident physicians, attending physicians, and advanced practice providers (APPs).

Results: Of the 87 survey respondents, 69% were trainees, 26% were attendings, and 5% were APPs. 66% of respondents were familiar with the terms “anticipatory guidance and patient self-management”, and a majority were able to identify specific components (84-94%). However, only 33% of providers endorsed that these concepts were part of their discharge practice (28% of trainees and 44% of licensed independent practitioners (LIPs)). 100% of respondents agreed or strongly agreed that providing patients information about what to expect after discharge and how to manage anticipated problems is valuable and could contribute to safer discharges, and 91% of providers agreed or strongly agreed that they had the knowledge and skills to provide patients with anticipatory guidance (87% of trainees and 100% of LIPs).

Conclusions: Our survey shows that hospital-based providers are familiar with the concepts of anticipatory guidance and patient-self management and find value in providing this information to patients to improve discharge safety. However, only a minority of providers incorporate these important concepts into their discharge practice. This represents an important opportunity for quality improvement. Improvement efforts should consider that this opportunity is not unique to trainees and does not seem to be related to a lack of awareness or skill to provide this information to patients.