Background: Effective discharge education is important to help patients understand their medications and follow up appointments, thereby improving adherence and reducing risk of readmissions. Our institution’s electronic medical record has a standard After Visit Summary (AVS) that is utilized by nursing staff to educate patients on the discharge care plan and then given to patients to take home for reference. Feedback from patient representatives and nursing staff revealed that the layout of this document is not user friendly with the most relevant information spread out over several pages and the medication section lacking reasoning behind changes. These deficiencies understandably foster confusion for both patients and nursing during this critical process. There is an optional free-text Message to Patient (MTP) section which appears at the top of the AVS however this was previously rarely used by providers and often left completely blank.
Purpose: To promote patients’ understanding of the discharge care plan by incorporating a standardized dot phrase in the MTP section of the AVS along with the secondary goals of improving nursing empowerment to provide excellent discharge education as well as improving patient satisfaction with the discharge process.
Description: The dot phrase was developed by a multidisciplinary group of hospitalist physicians, nurses, patient and family advisors, and resident trainees and includes three sections: follow-up appointments, upcoming labs / imaging, and a list of the most pertinent medication changes accompanied by reasons for the change. The dot phrase was initially piloted across a small group of resident trainees, nurses and patient representatives to test usability and solicit feedback for improvement. Subsequently, we implemented the dot phrase across all the internal medicine resident teams. This occurred in two phases – first by teaching the existing Internal Medicine residents and then again by teaching the new intern class of 2025 during their orientation to use it as a part of their discharge workflow. We manually reviewed a random sample of patient charts after each phase of education to assess the adoption of the standardized dot phrase by providers.The initial pilot revealed positive feedback from users. 100% of residents interviewed (n=7) felt it was easy to incorporate it into their discharge workflow and 85% believed it would have a very positive effect on patient understanding of their medication changes. 100% of nurses interviewed (n=4) wanted providers to continue using the phrase and 75% felt that its use would have a very positive effect on patient’s understanding of medication changes as well as any upcoming labs or imaging as a result of the admission. All three of the patient representatives agreed that use of the dot phrase favorably impacts patients’ understanding of their discharge medications. Manual review of randomly sampled charts revealed a significant increase in the adoption of the dot phrase by resident trainees after each cycle of education (37% and then 70%).
Conclusions: We successfully piloted and implemented a smart phrase to promote patients’ understanding of the discharge care plan across the internal medicine resident teaching service. Overall this is a low cost, easy to use, and widely generalizable intervention that can significantly improve the patients’ patient understanding of their care.