Nurse–physician communication is essential to ensure consistent and complete discharge instructions to patients. Though comprehensive discharge education can improve patient understanding and may reduce unnecessary rehospitalization, little is known about nurse and physician communication practices around patient discharge education.
Nurses, interns, and hospitalists caring for medicine patients in a 600–bed academic medical center were surveyed regarding discharge education practices in January 2011. The survey asked respondents about 14 elements of discharge education found in the literature. For each element, participants were queried regarding (1) the frequency with which they communicated this teaching to patients, (2) the provider responsible for this element of patient education, and (3) how often they directly communicate with the nurse or physician caring for the patient about each element. Questions on frequency were reported in a Likert scale (5 – always, 4 – often, 3 – sometimes, 2 – rarely, and 1 – never) Participants also reported on barriers to delivering comprehensive discharge instruction and their recommendation for tools to improve nurse–physician communication.
One hundred and twenty–nine providers responded to the survey with an overall survey response rate of 129/184 (70%) providers. Forty–five (64%) nurses, 56 (71%) interns, and 28 (78%) hospitalists participated in the survey. The majority of physicians and nurses agreed that 12 of the 14 elements should be a combined responsibility and 2 of the elements should be a physician responsibility. However, nurses communicated those 12 elements significantly more often than physicians (p < 0.05 for all), and physicians communicated their elements inconsistently. Despite the majority of items being agreed on as a shared responsibility, 44% of nurses and 39% of physicians reported never or rarely communicating with the other around any elements of discharge education. Nurses were more likely in general to favor communication tools around discharge than physicians, but both nurses and physicians were most supportive of standardized verbal communication on the day of discharge (100% and 81%, respectively).
Despite agreement on overlapping responsibility, nurses provide the majority of discharge education and interprovider communication is low. As lack of comprehensive discharge instructions has been linked to increased readmissions, solutions are needed to improve discharge communication. Both parties strongly favor a solution that involves standardizing face–to–face communication.
|Elements of Discharge Education||Agreed on Responsibility||Communicated by Nurses||Communicated by Physicians|
|Follow–up appointment dates and times||Combined||4.67||3.24|
|Signs and symptoms that may develop and when to seek care (e.g., call physician, 911)||Combined||4.65||2.94|
|Discharge medical diagnoses||Combined||4.60||3.90|
|Symptom management at home (e.g., pain, SOB, nausea)||Combined||4.55||2.94|
|Instructions for self–care (e.g., diet, activity, wound care)||Combined||4.53||2.43|
|Explanation of diagnosis in lay terms||Combined||4.33||3.98|
|Medication teaching and schedule||Combined||4.28||2.07|
|Home health services ordered||Combined||4.13||2.94|
|Changes to medication regimen made during hospitalization||Combined||3.98||3.46|
|Contact information for postdischarge questions||Combined||3.90||2.2|
|Reason for follow–up appointments||Combined||3.64||3.25|
|Written materials to help understanding of the procedure or disease||Combined||2.88||1.82|
|Summary of hospital findings and treatments given||Physician||2.4||3.42|
|Pending work up and test results||Physician||1.96||2.52|