Hospitals across the U.S. are doing everything they can to reduce readmissions. A new study offers facilities one more factor to look at when it comes to reducing readmissions – discharge summaries.
The study, which was recently published in The American Journal of Surgery, found less than one-quarter of patients leaving the hospital can actually comprehend the instructions they’re being sent home with that detail their follow-up care.
That’s a big financial problem for hospitals because patients with poor health literacy – an individual’s ability read and understand information needed to make health-related decisions – add more than $73 billion of added costs to the healthcare system each year. Reason: They have more frequent readmissions with longer stays and are at a higher risk for seeking emergency care.
The American Medical Association already recommends that all written health information be done on a 6th grade level to be understood by the average adult. Unfortunately, when it comes to discharge summaries, this study shows that’s not happening. On average, the discharge summaries were written on a 10th grade reading level.
A total of 497 patients were included in the study. The patient records were reviewed for age, sex, race, marital status, highest level of education obtained, mechanism of injury, injury severity score, hospital length of stay and dismissal disposition. The primary outcomes were hospital readmissions and documented calls to the service within 30 days from discharge.
After correcting for grammatical errors and spelling mistakes, readability of the text was determined using the Flesch-Kincaid grade level (FKGL) and Flesch reading ease scores (FRES) scales.
Patient education data was available for 314 patients, the majority of held a general education development degree or graduated from high school. Seventy had a college or postgraduate degree, 14 were “functionally illiterate,” 127 were “marginally literate.”
On average, the discharge summaries required at least a high school education to understand them. And deciphering the notes didn’t seem to be affected by whether the patients had surgery or by their length of stay in the hospital.
According to the researchers, limitations of the study included:
- lack of education data for all the patients
- exclusion of non-English speakers, and
- use of one formula to determine readability of medical documents when there are over 200 readability formulas that use different mathematical indices to calculate the readability of texts.
Written for two audiences
So why are discharge summaries so hard for patients to understand?
In a Reuters Health article, Dr. Martin Zielinski, a trauma surgeon at the Mayo Clinic in Rochester, MN, and the senior study author, pointed out that part of the problem is the discharge summaries are written for patients who need simple instructions and their doctors, who are used to medical jargon.
He also pointed out in an email to Reuters, “Even if patients believe they understand what occurred during their hospitalization and the instructions they are to follow upon dismissal, they can become confused after they leave the hospital environment as their memory can be clouded by medications they were administered, the stress of hospitalization, and, particularly within our patient population, traumatic brain injuries such as concussions.”
Fixing the problem
Discharge instructions give patients important medical information they need to help them management their own care. If the majority of patients can’t understand them, fixing this problem could have a huge financial impact on readmissions.
One fix, recommended by the researchers is for healthcare providers to explain terminology “in their respective fields to aid in patient comprehension.”
They also recommended:
- Adding illustrations
- Reviewing the discharge summaries with patients, their families and their care providers before they leave the facility
- Using a “teach-back” technique which requires patients to repeat and explain key info in the summaries
- Making patients aware of information intended for their care providers and separating it from the content specifically for patients, and
- Encouraging patients or their families to call the nurses’ station on the hospital floor where they were treat or call their doctor’s office if they don’t understand their discharge summaries or have any questions about their condition.