Background: Preventable hospital readmissions are a common problem for medical centers in the United States. Recent studies have focused on what patients perceive as causes for their return to the hospital. One factor driving readmissions is patients’ difficulty anticipating what to expect after they leave the hospital despite discharge instructions, especially anticipating and surmounting challenges that arise with obtaining and adhering to discharge medications. Discrepancies between discharge medication lists and patient-reported regimens are common, affecting up to half of patients. These discrepancies can lead to patient harm, including preventable adverse drug events and hospitalization. Systematic reviews of medication reconciliation programs have yielded mixed results with a heterogeneity of interventions, patient populations, and settings limiting their generalizability.
Time constraints and lack of standardization often hamper effective communication about potential post-discharge obstacles. Even when patients perceive that their discharge plan was adequate, many have poor comprehension of written instructions. Interventions that standardize discharge education while engaging the patient and improving their self-efficacy in successfully overcoming medication-related barriers may help reduce harm and preventable hospitalization.
The use of video discharge education (VDE) may provide a standardized and effective complementary education to spoken and written instructions. Evidence of VDE improving patient discharge comprehension exists in the Emergency Department literature, but has not been studied in the inpatient general medicine literature.
Methods: We conducted a single-arm intervention feasibility trial to evaluate the use of video education in participants who were being discharged home from the hospital. Pre- and post-intervention self-efficacy involving five different medication barriers was measured using a 5-item self-reported instrument. We also assessed knowledge retention, patient and nursing feedback, follow-up barrier assessments, and hospital revisits within 30 days.
Results: Forty patients participated in this study. Mean age was 52 years and 63% were women. Self-efficacy scores ranged from 5-25 with higher scores representing greater self-efficacy. Median pre- and post-intervention scores were 21.5 and 23.5, respectively. We observed a median increase of 2.0 points from before to after the intervention (p=0.046). Ninety-five percent of participants reported knowledge retention and 90% found the intervention to be helpful.
Conclusions: We observed that VDE improved patient self-efficacy surrounding discharge medication challenges among a general medicine inpatient population. Further, nursing feedback found positive views of the discharge intervention, with many nurses stating that VDE could increase their discharge efficiency. VDE may offer a novel and feasible way to deliver standardized information about often unanticipated discharge medication barriers.