Standardized Discharge Instructions to Promote More Effective Transitions of Care

From the 2021 HVPAA National Conference

John Santucci III (Department of Medicine, NYU Grossman School of Medicine), Kevin P. Eaton (Department of Medicine, Division of Hospital Medicine, NYU Langone Health),

Background

Hospital discharges challenge providers to communicate detailed and nuanced information to patients in a short amount of time. Unfortunately, this transition of care is often rushed and vital information is not communicated to the patient. Discharge instructions have remained the mainstay of how information is shared at the end of hospital stays, but their quality is highly variable and require that a provider dedicate sufficient time to ensuring they include the necessary information. This often would include reason for admission, return precautions, important medication changes, pending results, and follow-up. When this information is omitted, patient confusion ensues.

Objective

To improve provider workflow and communication around patient discharge education through the design and implementation of a comprehensive, concise, and standardized template for discharge instructions.

Methods

Using Epic™ electronic medical record software, a standardized template for discharge instructions was created with selectable smart list elements. The initiative was implemented on a 32-bed housestaff-run general medicine unit. Providers were instructed to use the template in the free text space for discharge instructions at the beginning of the After Visit Summary. A weekly email was sent to providers on service to encourage template utilization. Housestaff and nurses were surveyed regarding the perceived efficacy of the template in communicating essential information to patients as well as its effect on workflow as compared to prior free text instructions. The unit’s HCAHP scores were tracked for the discharge instruction domain.

Results

Over 60% compliance was observed for 3 consecutive months. Surveyed residents (n = 9) rated the discharge instructions on average as comprehensive while still serving to accelerate their workflow. Nurses (n = 10) identified the most common question at the time of discharge was information regarding medication changes and that the new template served to address this domain directly. Placement of the discharge instructions on the first page of discharge paperwork was noted to be extremely effective and allow for ease in communicating such information to patients. The unit’s HCAHP scores for discharge information have trended higher monthly since implementation.

Conclusion

Standardized discharge instructions in a large academic medical center afford the opportunity to ensure patients receive the most relevant information as it relates to their admitting diagnosis and follow-up care. Here we created a template that accelerates workflow leading to widespread utilization by resident teams.

Clinical Implications

Patients who are provided with standardized discharge instructions receive higher quality discharge education allowing for safer transitions of care.