Patients Don’t Understand Hospital Discharge Info

Almost 400 elderly patients were discharged recently from a large medical center; 96 in 100 of them said they knew why they had been hospitalized, but only 6 in 10 could describe their diagnoses accurately. About 35 in 100 of the patients had trouble explaining why they were in the hospital in the first place, and about half recalled their doctor having scheduled a follow-up visit while the medical records showed only about 1 in 3 actually had one scheduled.

These study results, published in JAMA Internal Medicine, and reported by Reuters.com, show that although older patients believe they understand what health practitioners tell them on release from the hospital, many-too many-don’t.

In the last couple of years, the health-care establishment has emphasized the need to lower the rate of readmissions, which are defined as discharged patients being readmitted to the hospital within 30 days for the same problem or complications of it.

Although this effort focuses on hospitals following recommended medical guidelines to reduce readmissions, attention is now being paid to ensuring that patients know what to do after they leave the hospital.

Fewer readmissions not only indicate better care, they have financial implications. Medicare reimbursements for hospital care depend, in part, on a facility’s readmission rate, and unnecessary, additional care fuels medical cost inflation.

For people on Medicare, according to federal figures supplied by Reuters, hospital readmissions increase spending by an estimated $26 billion per year; about $17 billion of that is estimated be potentially preventable.

Earlier studies examined the discharge instructions patients were given and whether they were satisfied with the process of leaving the hospital. This study focused more on whether the patients actually understood what doctors told them.

Nearly 400 people 65 and older were surveyed about their experience after being discharged from Yale-New Haven Hospital. Their responses were compared those with what was written in their medical charts and the instructions they were given when they were released.

Most patients received instructions that included simple language about what symptoms to watch out for and advice about activities and diet; but 1 in 4 set of instructions used medical jargon to explain the patient’s medical condition, such as “myocardial infarction” instead of “heart attack.”

Fewer than 1 in 3 patients said they had been told while still in the hospital about their upcoming discharge more than a day in advance. Two in 3 recalled being asked whether they would have the support they needed at home after discharge.

In a commentary accompanying the new study, Dr. Karin Rhodes, director of the Center for Emergency Care Policy and Research in the Department Of Emergency Medicine at the University of Pennsylvania, advised hospitals to make patient discharge a specialized team effort. The study’s authors suggested that hospitals employ a teach-back method. That’s when the patient repeats and explains the instructions back to their care provider to ensure they’re understood.

That idea is similar to the National Patient Safety Foundation’s “Ask Me 3” campaign, which recommends patients always ask their doctors three questions: What is my main problem? What do I need to do? Why is it important for me to do this?

Patients also should write down questions as they occur to them and make sure their caregivers answer all of them before leaving the room. As we’ve said repeatedly in this blog, keep asking questions until you’re satisfied with the answers; it’s your right and your responsibility as a patient.

The researchers reinforced the human element of good care in the Reuters story, saying that doctors should evaluate their practices to ensure they’re focused on the patients and not just on meeting regulatory benchmarks.

“I think it would be helpful to call a few patients and ask the patients the questions we did,” the leader author said.

For additional information, see our blog, “Avoiding a Return to the Hospital,” and Patrick’s newsletter, “When Hospital Errors Follow You Home, and Into Your Soul.”

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