Skip to main content

Currently Skimming:

2 Overview of Issues Involved in Creating Better Discharge Instructions
Pages 3-14

The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.


From page 3...
... Alex Federman, associate professor of medicine at the Icahn School of Medicine at Mount Sinai, discussed what is known about current discharge and after-visit summary materials, and Darren DeWalt, associate professor of medicine at the University of North Carolina at Chapel Hill, addressed the links between discharge and after-visit summaries that are constructed in a health-literate manner and improved outcomes. DISCHARGE INSTRUCTIONS AND HEALTH LITERACY: POLICIES AND THEIR IMPLICATIONS1 It is always important, said Joshua Seidman, to think about health literacy in the context of understanding what people say and what people hear, let alone what they remember.
From page 4...
... Patients are also supposed to receive patient-specific educational resources to help put the conveyed information into a context that, together with education, would improve health literacy. In an ideal world, said Seidman, discharge instructions and patientspecific educational resources would account for the language that a patient speaks and whether the patient prefers to receive information in writing, in graphical forms, or even as links to video or audio clips delivered via a mobile device such as a cell phone or tablet.
From page 5...
... INPATIENT AND AMBULATORY DISCHARGE SUMMARIES2 Noting that little research has been conducted on discharge instructions, Alex Federman discussed two of the few studies on physician-topatient communication that he was able to find in the literature. The first study examined the use of EHR-integrated treatment cards in a hospital in Geneva, Switzerland (Louis-Simonet et al., 2004)
From page 6...
... . Using an after-visit summary from his own institution that was generated by a widely used commercial EHR system, Federman discussed some of the issues with discharge instructions.
From page 7...
... . This report starts with a patient-friendly summary of why the patient had received care and a medication table that listed each drug's dose, the reason why FIGURE 2-1  Example of a discharge instruction sheet with useful features.
From page 8...
... Turning to an ambulatory visit summary, Federman noted that the meaningful use requirements dictate that such a summary be created after every visit and provided in either written or electronic format. The required elements for this summary include the patient's name, clinical office contact information, the date and location of the current visit, an updated patientspecific problem list, a medication list, vital signs, and the reason for the visit, including symptoms.
From page 9...
... LINK BETWEEN HEALTH LITERATE AFTER-VISIT SUMMARIES AND DISCHARGE INSTRUCTIONS AND IMPROVED OUTCOMES3 Darren DeWalt began the final presentation of the workshop's first panel by commenting that providing discharge instructions is now a part of the workflow in health care thanks to the meaningful use requirements issued by the Office of the National Coordinator for Health Information Technology but that there is still room for improvement. "This is a great opportunity to improve health care or to continue to create more waste," he said.
From page 10...
... At the time of his discharge, he was left with substantial cognitive impairment, difficulty with mobility, and an overwhelmed spouse. He also left the hospital with nine pages of discharge instructions that DeWalt stated were "difficult to sort through with a very small font." He added, "I can guarantee you that most of my patients are not referring to this information and that reading something like this is not particularly appealing for a medical patient that is still recovering from illness." Given this patient's status and the nature of the discharge instructions, DeWalt wondered whether the patient or family will make a mistake.
From page 11...
... He also wondered whether a medication list alone would have been sufficient at that moment in time and whether the problem list would help her in any way or whether it was just more information that would overwhelm her. In today's chronic care model, patient discharge instructions done well can be an important part of the productive interactions that can take place between an informed, activated patient and a prepared, proactive practice team and in the end produce good outcomes, DeWalt said.
From page 12...
... Both Federman and Seidman agreed with a comment from Kim Parson, director of the Consumer Experience Center of Excellence at Humana, who thought that bringing patients into the design phase for discharge summaries might produce a better product. Patrick McGarry, vice president for new business innovation and connected health at the American Academy of Family Physicians, expressed concern that, during treatment, patients concede locus of control for care, trusting that their clinicians will make appropriate decisions.
From page 13...
... Federman thought that "another driver could be the next iteration of meaningful use criteria if they were to say that the after-visit summary has to have demonstrated impact or has to meet some formatting or other characteristics that makes it health literate." Winston Wong, medical director for Kaiser Permanente's Community Benefit Disparities Improvement and Quality Initiatives program, said that giving health-literate instructions is critical but that it is also critical to provide support for a patient's transition back home. He then asked if any of the panelists had experience in making discharge instructions more understandable to non-English-speaking patients.
From page 14...
... Laurie Francis, senior director of Clinic Operations and Quality at the Oregon Primary Care Association and a roundtable member, asked how we can move from a focus on physician communication to one that concentrates on patient priorities and uses the care team to provide better care. Federman said, "Payment models." He pointed out that there are many ongoing demonstrations and research studies about engaging community health workers as members of the health care team.


This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More information on Chapter Skim is available.