Fellow: Jennifer K. Chen, Pediatric Hospital Medicine Fellow, Rady Children’s Hospital/UC San Diego
Article: Unaka NI, Statile A, et al. Improving the Readability of Pediatric Hospital Medicine Discharge Instructions. Journal of Hospital Medicine 2017; 12(7):551-557.
Summary: Many children’s caregivers have limited literacy, which may make it difficult for them to understand and carry out post-hospitalization care plans. Unaka et al performed a quality improvement (QI) project to increase the percentage of discharge instructions written at a seventh grade level or lower for hospital medicine patients. They used multiple plan-do-study-act (PDSA) cycles including implementation of a general discharge instruction template in the electronic health record (EHR), visible reminders and tips, implementation of disease-specific instruction templates in the HER, and individualized provider feedback. Over 6 months, the percentage of seventh grade level discharge instructions increased from 13% to 98%, well above the initial goal of 80%, and this was sustained for the following 4 months.
Key Strengths: This study led to a significant increase in readable discharge instructions for hospitalized children and demonstrated sustained improvement after the project ended. They included multidisciplinary input from different types of providers as well as parents to develop templates that were generally easier for providers to use and families to understand.
Limitations: The study excluded limited English proficiency families, which make up a significant proportion of hospitalized children. Some of the interventions were time-intensive, e.g. individualized feedback, which may be difficult to implement elsewhere. The disease-specific templates only addressed common general pediatric diagnoses, so these may be less helpful for patients who have unique complex healthcare needs.
Major Takeaway Message: Discharge instructions should be written at a seventh grade or lower reading level, but many providers do not receive specific training on how to do this. A focused quality improvement effort significantly increased readability of discharge instructions, especially creating disease-specific discharge instruction templates in the EHR.
Describe How This Article Should Impact Our Practice: This study provides possible interventions that any hospital can use to improve the readability of their discharge instructions. It also brings up questions of how medical providers learn about health literacy and providing information that caregivers can easily understand.
Article: Unaka NI, Statile A, et al. Improving the Readability of Pediatric Hospital Medicine Discharge Instructions. Journal of Hospital Medicine 2017; 12(7):551-557.
Summary: Many children’s caregivers have limited literacy, which may make it difficult for them to understand and carry out post-hospitalization care plans. Unaka et al performed a quality improvement (QI) project to increase the percentage of discharge instructions written at a seventh grade level or lower for hospital medicine patients. They used multiple plan-do-study-act (PDSA) cycles including implementation of a general discharge instruction template in the electronic health record (EHR), visible reminders and tips, implementation of disease-specific instruction templates in the HER, and individualized provider feedback. Over 6 months, the percentage of seventh grade level discharge instructions increased from 13% to 98%, well above the initial goal of 80%, and this was sustained for the following 4 months.
Key Strengths: This study led to a significant increase in readable discharge instructions for hospitalized children and demonstrated sustained improvement after the project ended. They included multidisciplinary input from different types of providers as well as parents to develop templates that were generally easier for providers to use and families to understand.
Limitations: The study excluded limited English proficiency families, which make up a significant proportion of hospitalized children. Some of the interventions were time-intensive, e.g. individualized feedback, which may be difficult to implement elsewhere. The disease-specific templates only addressed common general pediatric diagnoses, so these may be less helpful for patients who have unique complex healthcare needs.
Major Takeaway Message: Discharge instructions should be written at a seventh grade or lower reading level, but many providers do not receive specific training on how to do this. A focused quality improvement effort significantly increased readability of discharge instructions, especially creating disease-specific discharge instruction templates in the EHR.
Describe How This Article Should Impact Our Practice: This study provides possible interventions that any hospital can use to improve the readability of their discharge instructions. It also brings up questions of how medical providers learn about health literacy and providing information that caregivers can easily understand.