A significant percentage of patients do not remember or understand the instructions they receive before leaving the hospital, according to a study in this month’s Journal of Hospital Medicine.
“Anyone who’s taken care of patients or put together a discharge plan only to have things not work out knows how frustrating that can be,” says lead author Jonathan Flacker, MD.
Dr. Flacker, assistant professor of medicine in the Division of Geriatric Medicine and Gerontology, Emory University School of Medicine, Atlanta, and coauthors Wansoo Park, PhD, and Addie Sims, MSW, surveyed a group of elderly patients shortly after discharge to determine their recall and comprehension of their pre-discharge instructions. Dr. Park is an assistant professor of social work at the University of Windsor in Ontario, Canada. Dr. Sims is director of Senior Services at Grady Health System in Atlanta.
They conducted telephone interviews with 269 patients 70 or older, or their caregivers, within 10 days of discharge from Grady Memorial Hospital in Atlanta. Most interviews were conducted within a mean of three days of discharge and lasted 20 to 30 minutes. No effort was made to determine the patients’ cognitive status or degree of health literacy.
The survey was an offshoot of Aging Atlanta, a project funded by the Robert Wood Johnson Foundation to study the overall care of older adults in the community. It asked 37 questions covering patients’ financial resources and activities of daily living as well as the nature of their discharge instructions.
The authors found the survey “feasible and easily administered,” but its results were somewhat discouraging. In 52% of the cases, respondents claimed no one spoke to them prior to discharge about caring for themselves at home. Almost as many (47%) says they were not given a phone number or the name of a person to call if they experienced problems at home. “Yet the number was on the discharge papers; 100% of the people received it,” says Dr. Flacker.
Also, 41% says they were not told what to do if they experienced problems at home. On a more positive note, only 13% of the patients had to call concerning problems, and 84% felt they had received enough help after returning home.
Of the 115 (43%) patients who said the received instructions prior to discharge, 103 (90%) remembered how they were delivered: verbally in 68 cases (63%), written in 11 cases (11%), and both ways in 24 cases (23%).
“Patients receiving instructions both verbally and in writing were more likely to report that they understood care instruction ‘very well’ versus ‘somewhat’ or ‘very little,’ ” the authors wrote. Of those who recalled being instructed on how to take their medication, 86% says they took their medicine correctly, compared with 62% who had no such recollection.
To those who can’t understand how someone might completely forget receiving discharge instructions, Dr. Flacker suggests thinking back to the first day of residency or medical school when “you’re handed a whole pile of stuff” while trying to acclimate to unfamiliar surroundings. “Add to that being uncomfortable, sick, and uncertain about the future, and a lot of what is said goes untransferred,” he says.
In an elderly population, cognitive status and poor health literacy are certainly important potential confounders, but “based on my experience, our results are not a whole lot different than those of other investigators who accounted for those factors,” says Dr. Flacker.