Background: Discharge education is a key component of safe transition from inpatient to outpatient care in the pediatric population. Project IMPACT (Improving Pediatric Patient-Centered Care Transitions) is a multi-site quality improvement project developed to improve care transitions for pediatric patients using a transition bundle. One bundle element focuses on thorough discharge education (DE) and the use of teach-back (TB) to confirm caregiver understanding of discharge instructions. However, little is known about caregiver attitudes toward TB or whether other communication techniques alter caregiver perception of education received. The purpose of this study was to assess caregiver attitudes about the use of TB for DE and to compare other components of nursing communication during the session with caregiver perceptions of the instructional session.
Methods: Observations and surveys were performed by one of two study group members for patients on the hospital medicine service under the age of 18 between 6/2017 and 11/2017. Patients were selected by convenience sampling. Observation of DE occurred after obtaining verbal consent from the discharging nurse using a hospital approved observation tool to assess use of TB and communication components such as seated position, eye contact, open ended questions, and plain language. Upon written consent, immediately following DE, caregivers participated in an 8-question survey combining yes/no, open ended and five-point Likert scale questions to ascertain perceptions of the DE received, including education helpfulness, if adequate time was allotted, and if the caregiver felt comfortable with the information provided; education was considered effective if caregivers strongly agreed with all three components.
Results: During the study period, 70 discharges were observed. Of the 70 discharges, TB occurred 61% of the time. Of the 70 observed discharges, 69 families agreed to participate in the post-discharge survey; 1 family declined participation. When TB was observed, caregivers accurately perceived it occurring 74% of the time; all of those that recognized TB occurring felt it improved their comfort with discharge information. DE was perceived to be effective 74% of the time; 26% of DE was categorized as needing improvement. TB was observed in 71% of the effective DE and in 33% of DE needing improvement. Medical jargon was avoided 92% of the time in effective DE and 83% of the time for DE needing improvement. Nurses sat 31% of the time during effective DE and 22% of the time during DE needing improvement.
Conclusions: The use of TB was associated with a better overall perception by caregivers of discharge education. Caregivers that perceived that TB had been done found it helpful. Discharge education was more likely to be viewed as helpful, not rushed, and associated with caregiver comfort with the information when the nurse is seated, jargon is avoided and teach back is used.