Improving the Quality of Inpatient Discharge Instructions: An Evaluation and Implementation of Best Practices. Issue 8 (August 2021)

• Record Type: Journal Article
• Authors: Rodwin, Benjamin A.; Bilan, Victor P.; Gunderson, Craig G.; Merchant, Naseema B.
• Is Part Of: Southern medical journal. Volume 114:Issue 8(2021)
• Page Start: 445
• Page End: 449
• Publication Date: 2021-08
• Subjects: discharge instructions -- hospital quality -- patient safety -- preventable readmissions; Medicine -- Periodicals; 610.5
• DOI: 10.14423/SMJ.0000000000001284
• Languages: English
• ISSNs: 0038-4348

Abstract

Abstract : Written discharge instructions for patients are an important part of the discharge process. They often do not contain information that is useful for patients once they leave the hospital, however. The authors show that sequential interventions, including educational outreach and redesigned templates, were successful in improving the quality of patient discharge instructions. Abstract: Objectives: Little is known about whether improving the quality of written discharge instructions can result in improved readmission rates and whether there are differences in the quality of discharge instructions based on provider and patient characteristics. We set out to determine provider characteristics associated with high quality discharge instructions and whether redesigned discharge instructions would lead to improvement in their quality and reduce hospital readmission rates. Methods: We instituted sequential interventions of educational outreach and a redesigned discharge instructions template and evaluated their quality using 11 metrics based on established best practices and subsequent 30-day readmission rates. Results: In total, 225 randomly selected charts were reviewed during a 15-month period. An average of 5.36 quality metrics were completed before our interventions, which increased to 5.61 after educational outreach and 7.16 after the template was redesigned. The risk standardized 30-day readmission rate fluctuated from a baseline of 10.48% to 12.71% and 10.97% following each intervention, respectively. Medical students completed significantly more quality metrics than interns, residents, or attendings ( P < 0.05 for all) and residents completed significantly more than attendings ( P = 0.014). Conclusions: Although an education intervention was ineffective in improving discharge instruction quality, a redesigned discharge instructions template did improve the quality of patient discharge instructions. Neither intervention led to a meaningful change in readmission rates. We also found significant differences in the quality of discharge instructions based on the level of training of the author of the discharge instructions.