Facilitating Patient Understanding of Discharge Instructions Workshop Summary (2014) / Chapter Skim
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3 Inpatient Discharge Summaries
3 Inpatient Discharge Summaries
Pages 15-26
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Benard Dreyer, professor of pediatrics at the New York University School of Medicine; Avniel Shetreat-Klein, assistant professor and associate medical information officer for Epic Operations at Mount Sinai Medical Center; and Man Wai Ng, chief of the Department of Dentistry at Boston Children's Hospital and assistant professor of developmental biology at the Harvard School of Dental Medicine, gave their reactions to that presentation. KEY ELEMENTS AND FORMATTING DISCHARGE INSTRUCTIONS1 One recent revision to CMS's Conditions of Participation that health care organizations must meet to participate in Medicare and Medicaid programs was the provision that all hospitals must have, in writing, a discharge planning process that applies to all patients.
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Williams noted that any case manager, if asked, will say that hospital discharge planning should begin with hospital admission, but that often does not happen. The Medicare guidelines say that the discharge planning process should include input from medical staff, postacute care facilities, patients, and advocacy groups, but Williams wondered how many hospitals actually integrate all of these inputs into discharge planning.
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. It explains why the patient was in the hospital and encourages health care providers to explain, in "living room language," definitions of any medical terminology as well as the medical terms.
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Primary Care Doctor: ___________________ Phone Number: ________________ DATE: ______________, ___ ____, 20___ TIME: _____: _____ __m Specialist Doctor: _______________________ Phone Number: _________________ DATE: ______________, ___ ____, 20___ TIME: _____: _____ __m FOLLOW-UP TESTS _____After leaving the hospital I will show up for my tests. (initials)
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Dreyer also remarked that smartphones, videos, and Web-accessible programs can be valuable tools for communicating with patients. For example, New York University Medical Center has developed a Web-accessible program that providers can access 3 This section is based on the presentation by Benard Dreyer, professor of pediatrics at New York University School of Medicine, and the statements are not endorsed or verified by the IOM.
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20 FACILITATING PATIENT UNDERSTANDING OF DISCHARGE INSTRUCTIONS FIGURE 3-2 Asthma medication plan. SOURCE: NYU School of Medicine, 2011, as presented by Dreyer.
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He stressed that we need to make sure the patient is ready and prepared for care after discharge, the family and home environment is ready for the patient, and the community and the health care system have the resources and responsibilities necessary for a successful transition. Avniel Shetreat-Klein4 Avniel Shetreat-Klein commented on the difficulty in getting EHRs to produce simplified, readable discharge instructions.
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Although patient checklists can be useful, Shetreat-Klein said, a matching physician checklist should be created in the EHR that would prompt the physician to address all the relevant issues germane to a specific patient. Alternatively, the patient could go over the checklist in the presence of the health care provider, which Shetreat-Klein suspected might make a difference in patient understanding and follow-through.
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The purpose of these three processes, she added, is to screen and identify individual patients for whom a lack of an adequate discharge plan will likely result in unnecessary delay from discharge or impact health after discharge. The discharge process, she continued, should ideally begin when the child arrives at the hospital, and it should involve all members of the care team.
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Williams noted that teach-back appears to improve patient satisfaction to a degree that gets reflected on patient satisfaction surveys used by CMS for hospital and physician reimbursement. He added that teach-back needs to be used by all members of the health care team, not just by the last person who sees a patient before discharge.
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Williams said that hospitals need to engage industrial engineers to support the development of better discharge instructions and to integrate electronic medical records into the workflow of the care providers to best serve the patients. Dreyer said that
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Ng said that it was critical to think about discharge instructions in terms of systems and that all stakeholders need to be involved in the planning process, with subsequent testing prior to implementation.
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