Background: The role of discharge instructions in post-discharge recovery remains unexplored. We examined the role of discharge instructions in post-discharge care for patients undergoing colorectal surgery and report themes related to patient perceptions of discharge instructions and post-discharge experience.
Methods: Semi-structured interviews were conducted as part of a formative evaluation of a Project Re-Engineered Discharge intervention adapted for surgical patients. Patients received an After Hospital Care Plan (AHCP) with warning signs and symptoms and hospital contact information specific for post-surgical patients. The AHCP adaptations for surgery were developed using literature review, a Delphi expert consensus panel, and process mapping with frontline medical staff. Patient interviews were conducted at the two-week post-operative follow-up appointment. The interviews were recorded, transcribed, and coded by 2 research team members. Our qualitative analysis utilized a deductive approach based on the AHCP content and an inductive approach using grounded theory to analyze transcribed interviews.
Results: Of 28 eligible patients who were consented and underwent surgery during the study period, research staff completed interviews with 12 patients. The majority of the participants demonstrated understanding of the significance of the warning signs and symptoms and appropriate actions to take. During the interviews, participants reported several positive roles for discharge instructions in their post-discharge care: a sense of security, a reminder of in-hospital education, a living document and a source of empowerment. Despite positive associations with discharge instructions, the majority of participants reported that the instructions provided insufficient information to effectively access care following discharge. Participants reported difficulty reaching providers after discharge, which resulted in the adoption of workarounds to overcome system barriers.
Conclusions: In our examination of tailored discharge instructions in post-operative recovery, participants understood the content provided in the AHCP and reported positive roles for discharge instructions in their post-discharge recovery. Despite concerted efforts to provide patient-centered information in the AHCP, the discharge instructions did not provide enough information to effectively guide post-discharge interactions with the health care system. Insufficient information for accessing the health care system and difficulties contacting providers following discharge are important barriers to patients receiving high quality post-discharge care. Discharge instructions should guide patients by linking common post-discharge problems with simple, yet specific instructions to contact the health care system resource that is best suited to manage particular post-discharge problems as they arise.