At the time of hospital discharge, patients were often not informed of important information, including what symptoms to expect or reasons for changes in medication, according to a study published in JAMA Internal Medicine.
“The day of discharge is a vulnerable time for patients as they transition to the outpatient setting,” Shreya P. Trivedi, MD, an academic hospitalist at Beth Israel Deaconess Medical Center, and colleagues wrote. “Prior studies have demonstrated that suboptimal communication contributes to inadequate understanding of post-discharge care plans, leading to preventable harms such as medication errors, adverse events, and costly readmissions.”
The researchers added that previous research has also shown “a lack of clarity” amongst team members over who is responsible for presenting information to patients.
Trivedi and colleagues performed an observational quality improvement study to determine what information medicine-floor patients receive the morning of their discharge and from whom. The study involved 33 patients across two academic teaching hospitals and spanned from September 2018 to May 2020. The patients had a mean age of 63 years; 55% were men; and 42% were white individuals.
Of the discharged patients, 88% had to start new medication, change the dose of an existing medication or stop taking a prior medication. Among those with a new or changed medication, 28% were not told the name or its function. Additionally, 59% of patients were not counseled on the purpose of the medication by any team members. Of those who had their medication discontinued, 55% were not informed of the reason for discontinuation.
The researchers also wrote that more than half of patients (54%) did not receive any counseling on how to self-manage their primary discharge diagnoses, while 73% were not given instructions on the kinds of symptoms to expect following discharge or over the expected duration of their illness.
The majority of patients (82%) were not given any guidance on “red-flag” signs that should prompt an immediate return to care, while 42% were not asked if they had any questions.
“Overwhelmingly, the health care team provided substandard explanations to patients regarding discharge plans,” Trevedi and colleagues wrote.
They added that the results reinforce the need “to critically assess actual practices and operationalize informed implementation efforts.”
“Without discharge counseling on pending studies or symptom monitoring, a patient who feels relatively better may not understand the importance of follow-up,” they wrote. “These findings can inform efforts to reduce high no-show rates in clinics following discharge, which is shown to improve posthospitalization morbidity and adverse events.”
Trivedi and colleagues witnessed only one instance of a patient being asked to teach back what they had learned about discharge education, a strategy that they said has been associated with reduced readmissions.
“These missed opportunities shed light on a larger problem: lack of integration of evidence-based interventions into routine discharge practice,” they wrote. “There may be a gap between health services research findings and clinician educators, such that these communication skills may be touched on briefly during limited transitions-of-care curriculums.”
The researchers concluded that “further studies on effective communication strategies as well as systems redesign that foster patient-centered discharge education are imperative.”