Many hospital patients aren’t getting good instructions before being discharged

Hospitals must improve their communication with patients leaving the hospital to ensure they understand their medications and their care plan, researchers say.

Patients often don’t get good explanations on why they are receiving certain medications and the need for follow-up appointments prior to being discharged, according to a recent study published in Jama Internal Medicine.

Researchers say that patients need more information than they are getting. The authors also point out that if patients don’t grasp their treatment plan before they leave the hospital, they could end up being admitted again if complications arise. That’s obviously bad for patients, and it’s problematic for hospitals because they can face penalties from Medicare for high readmissions.

“Our descriptive analysis of discharge communication illustrates that overwhelmingly, the health care team provided substandard explanations to patients regarding discharge plans,” the authors wrote.

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The researchers acknowledge they looked at a small sample size. They examined 33 patients in two urban academic teaching hospitals on the morning of their discharge, noting that is a “vulnerable” time for patients.

The authors said they found several concerns with discharge instructions in their observations.

“These findings suggest that significant gaps occur in patient education on the morning of discharge and represent a target for interventions to decrease posthospital morbidity,” the authors wrote.

Most of the patients - 29 of 33 - began a new medication or had to change the dose of an existing prescription. Still, of those 29 patients with a new or revised prescription, eight patients (28%) weren’t told the name or basic function of the change in medication. More than half of the patients - 17, or 59% - didn’t get counseling on the reason for the change in medication by any member of the care team.

Nearly all of the patients - 31 of 33 - left the hospital with instructions for follow-up appointments. But 15 of the 31 patients weren’t told the reason for an appointment by the care team. In cases where providers explained the need for additional appointments, they usually did so in response to direct questions from the patients.

Most of the patients - 28 of 33 - were never asked any questions by the hospital team about potential barriers to following the care plan, such as difficulty with transportation in getting to an appointment or to a pharmacy to pick up prescriptions. A substantial number of patients (42%) were never asked if they had any questions.

Only one patient was asked by a physician about their understanding of the discharge plan and to repeat the instructions to ensure the guidance was clear. The Agency for Healthcare Research and Quality has recommended the “teach-back” method to ensure patients understand their discharge instructions, but the study suggests it is rarely used.

The authors suggested that may indicate a larger problem: a gap between health services research findings and clinician educators.

While researchers focused on instructions on the day of discharge, the authors conceded it was possible some patients received more thorough instructions earlier. But they said 80% of patients reported that they had no prior instruction.

The study found that attending physicians spent a median of 3 minutes on the morning of a patient’s discharge, while interns spent four minutes. Nurses spent a median of 22.5 minutes on the morning of discharge, the study found. Most nurses explained to patients the names and functions of key medications during discharge instructions, the authors said.

Still, the authors found plenty of room for improvement. Researchers noted that previous studies found poor discharge instructions can lead to adverse events and expensive readmission to the hospital.

“Our findings reinforce the need to critically assess actual practices and operationalize informed implementation efforts,” the authors wrote.

A University of Michigan study released last June found deficiencies in transitions from the hospital to home. In that study, researchers found roughly one in five patients didn’t get any follow-up calls after leaving the hospital, and Black patients were less likely to see a physician after being discharged.