Understanding and execution of discharge instructions

Am J Med Qual. 2013 Sep-Oct;28(5):383-91. doi: 10.1177/1062860612472931. Epub 2013 Jan 25.


Discharge from the acute care hospital is increasingly recognized as a time of heightened vulnerability for lapses in safety and quality. The capacity of patients to understand and execute discharge instructions is critical to promote effective self-care. This study explores factors that predict understanding and execution of discharge instructions in a sample of 237 recently discharged older adults. A study nurse conducted a postdischarge home visit to ascertain patient understanding and assess execution of instructions. Health literacy, cognition, and self-efficacy were important predictors of successful understanding and execution of instructions. Neither discharge diagnosis nor complexity of discharge instructions was found to be a significant predictor of these outcomes. Results indicate a need to implement reliable protocols that identify patients at risk for poor understanding and execution of hospital discharge instructions and provide customized approaches to meet them at their respective levels.

Keywords: care coordination; care management; discharge planning; hospital readmission; person-centered care.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Aged, 80 and over
  • Comprehension
  • Female
  • Health Literacy
  • Humans
  • Male
  • Middle Aged
  • Patient Discharge* / standards
  • Risk Factors
  • Self Care / methods
  • Self Care / psychology
  • Self Efficacy