From the 2022 HVPA National Conference
John Santucci III MD (NYU Langone), Jamie Schlacter BS (NYU Langone), Kevin Eaton MD
Background
Hospital discharges represent a vulnerable transition of care for patients. Discharge instructions are intended to summarize vital information pertaining to the patient’s hospital stay and outline next steps in their recovery. Complete discharge instructions frequently summarize the reason for admission, provide return precautions, highlight important medication changes, identify pending results, and ensure adequate follow-up is scheduled. Without standardized protocols, discharge instructions are of variable quality and detail. Creating tools to write clear, comprehensive discharge instructions can accelerate provider workflows and facilitate safer transitions of care.
Objective
In this quality improvement initiative, we expanded the use of our standardized template for discharge instructions to both resident led and advanced practice provider teams. We analyzed the impact of our template on the quality of discharge instructions provided to patients. We concluded our review by comparing Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores for domains pertaining to provider-patient communication and discharge information before and after our intervention.
Methods
Using Epic™ electronic medical record software, a standardized template for discharge instructions was created. Medicine residents, advanced practice providers, and nurses were educated on the use of the template. The template was included on the first page of discharge materials. Randomly selected discharge instructions prior to (n = 92) and after template introduction (n = 88) were selected for analysis. An overall quality score was assigned out of 7 points, each point reflecting a different scoring category. The categories included: admission diagnosis, key hospital administered treatment, return precautions, medication changes, follow-up appointments, follow-up testing, and organization of information. Each individual category was scored on a binary scale as either present (1 point) or absent (0 points). Discharge instructions were considered compliant if they included return precautions plus information from one of the other categories listed above. HCAHPS scores for discharge domains and provider-to-patient communication were compared before and after template introduction.
Results
For resident led teams, the mean total quality score significantly increased after introduction of our discharge template (2.34 ± 0.212 vs 5.90 ± 0.188; pre- vs post-template). Compliance for completing discharge instructions similarly increased (21.7% vs 85.2%; pre- vs post-template). Despite cessation of weekly reminder emails, compliance remained high. During the period after template introduction, a correlative increase in HCAHPS scores was appreciated for discharge domains and provider-to-patient communication.
Conclusion
The deployment of standardized discharge instructions template in an academic medical center experienced high rates of user compliance and led to improved quality of discharge instructions.
Clinical Implications
Standardized discharge instructions ensure patients receive the relevant information necessary to promote safer transitions of care.
