a major reason for this is poor physician-patient interaction , resulting from a poor understanding of discharge instructions ( Gignon et al ., 2014 ). Patients simply cannot follow instructions that they do not understand .
Readmission
Hospital readmission metrics record data on patients who are discharged and then return to the hospital to be seen for complications related to the original visit . A lower rate is reimbursed by Medicare when this occurs within 30 days or if readmissions seem excessive ( Joynt & Jha , 2013 ). In turn , the hospital loses money Since this is important to the hospital , it is also important to take a look at why a patient returns . In many cases , it is because they did not follow discharge instructions that recommended a followup visit or prescription .
Regulatory Compliance and Reimbursement Issues
The Joint Commission ’ s core measure for a heart failure diagnosis states that hospital-written discharge instructions should include the topics of treatment , diet , activity , daily weight ( Herring , Smith , Ripley , & Farmer , 2014 ), follow-up instructions , discharge medications , and what to do if symptoms get worse ( Albrecht et al ., 2014 ). Some hospitals include all of these items with every discharge regardless of the diagnosis , along with other diagnosisspecific information ( Albrecht et al ., 2014 ). Failure of this type of core measure can have financial reimbursement consequences for a hospital .
Patient Safety
A review of written discharge instructions by a RN will often show mistakes related to a wrong reported diagnosis , medication discrepancy , and an incomplete medication list ( Herring et al ., 2014 ). Last minute changes and rushing to discharge a patient “ often results in the ‘ reconciliation ’ being flawed ” ( Moran , 2012 , p . 134 ). As the second-to-last line of defense to patient safety , it is important that accurate discharge paperwork is given . The last line of defense is the patient . This is why it is important that s / he fully understands the discharge instructions .
Consumer Satisfaction
Research shows that teaching patients to take care of themselves empowers them to take responsibility for their own health ( Jamarik , 2016 ). To increase satisfaction , some hospitals add information to the discharge instructions packet , including discounted prescription cards , lists of providers , and smoking cessation information ( Herring et al ., 2014 ).
Recommended Evidence-Based Interventions to Address Patient Safety
Patients should never walk out of the ED asking : What treatment did I get in the ED ? What is the next step in recovery ? Where , when , and with whom do I followup ? What are my medications ? Under what conditions should I return to the ED ?
Patient safety involves ensuring patients have received good communication regarding their ED visit . If the patient cannot understand the instructions , the family or caregivers must be able to understand them .
Patient Teach-Back
Studies show that more than half of patients are noncompliant with important ED discharge instructions and the same percentage admitted that they had trouble understanding the prescription given to them at discharge ( Gignon et al ., 2014 ). One way to make sure patients understand their discharge paperwork is to teach them and then have them “ teach back ” ( Jamarik , 2016 ) what they learned to the person giving the instructions . Using his / her own words , the patient would repeat the instructions back to the RN . If the RN feels that there is comprehension , then the teaching moment was a success ( Jamarik , 2016 ).
Gignon et al . ( 2014 ) showed that even when patients did not understand their instructions during the discharge , they would not tell the RN or ask questions . Therefore , the teach-back method is important when reviewing the discharge paperwork .
Teaching the Family
Much of the care after discharge will be regulated to the patient ’ s family or other caregivers ( Hill , 2014 ). Therefore , it is important to have caregivers participate in the discharge teaching . They
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