Quality of discharge practices and patient understanding at an academic medical center

Abstract

Importance: With growing national focus on reducing readmissions, there is a need to comprehensively assess the quality of transitional care, including discharge practices, patient perspectives, and patient understanding.

Objective: To conduct a multifaceted evaluation of transitional care from a patient-centered perspective.

Design: Prospective observational cohort study, May 2009 through April 2010.

Setting: Urban, academic medical center.

Participants: Patients 65 years and older discharged home after hospitalization for acute coronary syndrome, heart failure, or pneumonia.

Main outcomes and measures: Discharge practices, including presence of follow-up appointment and patient-friendly discharge instructions; patient understanding of diagnosis and follow-up appointment; and patient perceptions of and satisfaction with discharge care.

Results: The 395 enrolled patients (66.7% of those eligible) had a mean age of 77.2 years. Although 349 patients (95.6%) reported understanding the reason they had been in the hospital, only 218 patients (59.6%) were able to accurately describe their diagnosis in postdischarge interviews. Discharge instructions routinely included symptoms to watch out for (98.4%), activity instructions (97.3%), and diet advice (89.7%) in lay language; however, 99 written reasons for hospitalization (26.3%) did not use language likely to be intelligible to patients. Of the 123 patients (32.6%) discharged with a scheduled primary care or cardiology appointment, 54 (43.9%) accurately recalled details of either appointment. During postdischarge interviews, 118 patients (30.0%) reported receiving less than 1 day’s advance notice of discharge, and 246 (66.1%) reported that staff asked whether they would have the support they needed at home before discharge.

Conclusions and relevance: Patient perceptions of discharge care quality and self-rated understanding were high, and written discharge instructions were generally comprehensive although not consistently clear. However, follow-up appointments and advance discharge planning were deficient, and patient understanding of key aspects of postdischarge care was poor. Patient perceptions and written documentation do not adequately reflect patient understanding of discharge care.

Figure 1

Flow diagram of enrolled participants

Figure 2

Panel A: Word cloud of 30 most common phrases describing reason for hospitalization in written discharge instructions to patients Panel B: Word cloud of 100 most common phrases describing reason for hospitalization used by patients

Figure 2

Panel A: Word cloud of 30 most common phrases describing reason for hospitalization in written discharge instructions to patients Panel B: Word cloud of 100 most common phrases describing reason for hospitalization used by patients