Background: The hospital discharge is one of the most important aspects of a patient’s hospitalization, yet in residency training, this process often goes overlooked. Most residents are never properly taught how to effectively discharge a hospitalized patient. As a sequelae, patients often lack understanding about their hospitalization, treatment(s), and follow up plans. This uncertainty can lead to poor patient outcomes and negatively affect patient experience. By standardizing and improving upon the discharge process, we hope to create a best-practice, which will ultimately improve care transitions and patient satisfaction.
Purpose: Research shows that when patients are more involved in their care, there is increased satisfaction, adherence to treatment and follow up. By standardizing the hospital discharge, The ECLIPSE Project improves this process by focusing on three key elements:1)To improve the patient’s health literacy.
2) To foster the patient’s sense of disease ownership.
3) To improve the care transition.
Description: At the time of discharge, to prevent any discrepancies between nursing and the physician team, the discharging resident and the patient’s nurse simultaneously meet with the patient to provide comprehensive discharge counseling and answer any questions that should arise.
The resident reviews the patient’s primary diagnosis and provides an informational hand out to the patient (American College of Physicians patient -related resource print out). In addition, a comprehensive review of the patient’s hospital course, medicine reconciliation, and follow up plan is provided. This counseling is organized by using The COMPLETES (NOW) (Fig. 1) protocol. This protocol emphasizes the teach-back method, which helps confirm that the physician has clearly communicated the information by insuring that the patient can teach back the information in their own words. Patients discharged on “high -risk “ medications (such as antibiotics, opiates, benzodiazepines, anticoagulation, and insulin) are provided additional medication counseling by a clinical pharmacist. The patient is provided an envelope, that includes a checklist of items that the patient initials, once they demonstrate an understanding of their medications, discharge instructions, follow up appointments and who to contact should there be any questions after their discharge. Implementation of the ECLIPSE Project is reinforced via a newly created discharge advocacy team, composed of resident physicians who meet with medical floor teams to help assist the discharge process. To add to the rollout effort, a poster highlighting the new process was also created and will be placed in each resident team room.
Conclusions: The ECLIPSE project creates a new standard for the discharge process, by improving patients’ health literacy, disease ownership, care transition and ultimately patient satisfaction. This is accomplished by providing comprehensive counseling via a multi-faceted approach. Ingredients include disease informational handouts, the COMPLETES (NOW) protocol, a discharge checklist (completed by the patient), additional pharmacist counseling, and a focus on the patient teach-back method. This initiative was piloted on a medical ward, and during that month, we saw a 96 point percentile increase in discharge information satisfaction and a 25 point percentile increase in care transitions, as reflected on the HCHAP surveys.
.jpg)