Introduction
Hospital discharge instructions provide critical information necessary for patients
to manage their own care; however, often they are written at a substantially higher
readability level than recommended (ie, 6th-grade level) by the American Medical Association
and the National Institutes of Health. We hypothesize that improving the reading level
of discharge instructions will decrease the number of patient telephone calls and
readmissions in the posthospital setting.
Methods
We conducted a prospective observational study. Patient discharge instructions were
edited and incorporated to enhance the readability level in August 2015. Return telephone
call and readmissions of patients admitted before the intervention from August 1,
2014, to January 31, 2015, were compared with the prospective cohort studied from
September 1, 2015, to September 30, 2016.
Results
A total of 1,072 patients were included (preintervention: n = 493, postintervention: n = 579). Patient demographics, injury characteristics, and education level were similar
among both groups. The median discharge instruction readability level in the postintervention
group was significantly lower (10.0, 95% CI 10.0–10.2 vs 8.6, 95% CI 8.8–8.9; P < .0001). The proportion of patients calling after hospital discharge was significantly
reduced after the intervention (21.9% vs 9.0%; P < .0001). Monthly hospital readmissions were decreased by 50% for every 100 patients
discharged after the intervention (1.9% vs 0.9%; P = .002). The proportion of patients calling and readmissions for poor pain control
significantly decreased after the intervention (7.1% vs 2.59%; P = .0005 and 2.8% vs 1.0%; P = .029, respectively).
Conclusion
Enhanced readability of discharge instructions was associated with a decrease in the
number of telephone calls and readmissions in the posthospital setting, enhancing
health literacy and simultaneously reducing the burden on providers. Improved patient
instructions written to an appropriate level may also allow for better pain control
in the posthospital setting.
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Article info
Publication history
Published online: November 19, 2018
Accepted:
October 13,
2018
Received in revised form:
September 22,
2018
Received:
August 1,
2018
Footnotes
Supported by CTSA Grant Number UL1 TR000135 and KL2 TR000136 from the National Center for Advancing Translational Sciences, a component of the National Institutes of Health. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of the National Institutes of Health.
Presented in part at the 2017 Clinical Congress of the American College of Surgeons.
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
