Communicating discharge instructions to patients: a survey of nurse, intern, and hospitalist practices
This is a first review of the article "Communicating discharge instructions to patients: a survey of nurse, intern, and hospitalist practices." 
Transition from inpatient to home is a vulnerable time for the patients. Studies have shown that about 20% of the patients, experience an adverse event at the time of discharge and one third of these events are potentially preventable. Many patients leave the hospital without clear understanding of their discharge instructions. Electronically created discharge instructions have been shown to be more complete when compared to the handwritten ones. The use of discharge coordinators, improved patient teaching techniques, and use of patient-centered education material all contribute towards better provider-patient communications at the time of discharge. However, the roles of different providers in communicating these discharge instructions to the patients remains at best vague. In this study, authors surveyed physicians and nurses in their hospital, to understand each groups’ own perceptions and roles in conveying these discharge instructions to the patients.
This study was done in University of California, San Francisco Medical Center (UCSFNC), which is a large tertiary care teaching hospital. A self-developed survey was administered to the interns, teaching hospitalist and daytime nursing staffs that were main participants in conveying these discharge instructions, at the time of discharge. The questions were selected to understand the perceptions of these providers about their role in patient discharge education; describe the current practice of conveying these discharge instructions to the patients and provider-nurse communication and to evaluate the willingness of these groups to embrace new communication tools. The authors also identified 13 critical discharge education elements, through literature search. The survey asked the respondents to identify parties (nurse, physician, both or neither) responsible for providing education for each of these elements and then to identify their own current practice of the same and in physician-nurse communication. The survey also elicited respondents’ interests in the use of new tools to improve provider communication at discharge.
The 13 critical identified discharge instruction elements are listed below:
1. Medication teaching and schedule 2. Contact information for post-discharge questions 3. Instructions for self-care 4. Follow-up appointment dates and times 5. Signs and symptoms that may develop and when to seek care 6. Symptom management at home 7. Home health services ordered 8. Reason for follow-up appointments 9. Changes to medication regimen made during hospitalization 10. Discharge medical diagnoses 11. Explanation of diagnosis in lay terms 12. Summary of hospital findings and treatments 13. Pending results from studies during hospitalization
All providers considered 9 out of the 13 elements a shared responsibility, though more nurses than physicians felt that way. Out of these 13 domains, domains of explaining summary of hospital findings and pending results from studies during hospitalization were considered mainly physician responsibility. For the remaining two domains of explaining diagnosis in lay term, interns felt that this was a nursing responsibility and interns also felt that providing patients with contact information was also a unique nursing responsibility.
Verbal communication as a method of communication between the providers on the day of discharge received most support and communication through the use of white board received the least support. Interns and hospitalists as compared to the nursing staff favored use of checklists to support communication though this difference did not reach statistically significant difference.
This study correctly identifies that multiple providers feel the responsibility of providing patient education around discharge. This study also highlights that none of the providers felt that providing education to the patients at the time of discharge is their sole responsibility. A structured, tailored to the local conditions, approach may be needed to better and reliably communicate discharge instructions to the patients.
This study identified that though many providers are willing to educate but none felt that all education falls under their domain. This identifies an area for improvement by creating a discharge team composed of a nurse trained in patient education, a pharmacist who can perform medication reconciliation at the time of admission and discharge and also provide patient education during the hospital stay and a social worker who can identify factors that can lead to failed discharges. This team may become responsible for all the discharges in their area and overtime may impact readmissions and adverse events post-discharge.
- Ashbrook L, Mourad M & Sehgal N (2013) Communicating discharge instructions to patients: a survey of nurse, intern, and hospitalist practices. Journal of Hospital Medicine 8, 36–41. http://www-ncbi-nlm-nih-gov.ezproxyhost.library.tmc.edu/pubmed/23071078