Background: In a community where health literacy remains a major challenge, patient discharge is a vulnerable period where patients often return home without fully understanding their disease diagnosis, discharge plan or medications. Patients often do not know which medications they are taking or why they were prescribed. This leads to poor adherence and increased risk of readmission. Our institution recognized this opportunity to improve discharge communication that will improve patient understanding of care plan and preparedness to transition to home
Methods: A Standardized discharge workflow for physicians, nurse, pharmacist and clerical team was instituted. Prior to discharge, the physician reaches out to the primary nurse to coordinate a convenient time to review the discharge care plan with patient and family. A structured discharge script that outlines discharge medications, reason for admission and follow up appointment was developed to guide a patient centered discharge discussion. At bedside, the physician and nurse jointly discuss the hospital course, follow up appointments and discharge instructions emphasizing each medication’s dosing and purpose. For non-english speakers, certified interpreters were used and patients/family were encouraged to restate instructions in their own words to ensure understanding. They were also provided with medication bags to keep their medications organized and were reminded to bring them to every appointment for accurate medical reconciliation. Clerical staff ensures accurate contact information is on file and that follow up appointments are scheduled prior to discharge. 72 hrs-post discharge calls were made by assigned staff to assess satisfaction, understanding and barriers to care. Medications were linked to their corresponding indications to help nurses provide accurate patient education. Monthly education sessions were held for all floor team residents to review and update workflow. A brief training video was created to illustrate the process to incoming residents and nursing staff.
Results: At the end of the 3 months after implementation, patient reports via post Discharge calls revealed that 97% of the time, the health care team used their preferred language and 94% of the patients reported understanding their discharge instructions. In 75% of the discharges both physician and nurse were together in the discharge discussion. 90% of respondents were able to state symptoms to watch out for. 62.5% of the discharges has a primary care appointment schedule. Patient experience metrics showed: communication regarding medication indication as well as side effects improved from 70-75% and 27-57% respectively. Good understanding of health improved 16 points, from 32% – 47.8%.
Conclusions: A structured, multilingual, multidisciplinary discharge process, with Realtime collaboration responsive to the patients’ individual level of health literacy improves patient satisfaction and comprehension as also reflected in patient experience metrics. This strengthens patients’ ability to play an active role in their continuity of care.