The Impact of Diagnosis-Specific Discharge Instructions on Patient Satisfaction

The Needs of Orthopaedic Patients in Discharge Planning

Introduction

Patients' transition from hospital to home could be challenging for patients and caregivers. This is of utmost importance for patients requiring special or long-term care such as post-orthopaedic surgery. Effective discharge planning is required to ensure that patients are prepared to and get continuous care after returning home to prevent complications. Patients' need assessment is essential to develop effective discharge planning to meet the patient's needs.

Materials and methods

This mixed-method study aimed to determine the patient's needs to develop a discharge planning for total knee replacement surgery. The needs for 96 total knee replacement patients were assessed using the Needs Evaluation Questionnaire (NEQ). The in-depth interview primary focus was to explore the lived experience of the post-total knee replacement patients receiving care in the hospital.

Results

A total of 96 participants (100%) completed the NEQ questionnaire. Most of the needs concerned by the participants were expressed by at least 70% of them except the financial need (59.4%). The semi-structured interview found two elements which were a support group and patients' needs in terms of emotional, physical and spiritual preparation in developing effective discharge planning.

Conclusion

This study clarified that the patient needs assessment in the patient care plan.

Audit of postoperative readmissions and patient messages following endoscopic transnasal transsphenoidal surgery

Objectives:To identify the reasons for patient messages, phone calls and Emergency Department (ED) visits prior to the first postoperative visit following discharge after endoscopic transnasal transsphenoidal (eTNTS) surgery. Design: Retrospective review of patients at a tertiary care academic center who underwent eTNTS for resection of a sellar region tumor between May 2020-August 2021. Patient, tumor, and surgical characteristics were collected, along with post-operative, post-discharge, and readmission information. Regression analyses were performed to investigate risk factors associated with post-discharge phone calls, messages, ED visits, and readmissions. Main Outcome Measures: Number of and reasons for phone calls, patient messages, and ED visits between hospital discharge and the first postoperative visit. We additionally determined whether these reasons were addressed in each patient’s discharge instructions. Results: A total of 98 patients underwent eTNTS during the study period. Median length of hospital stay was 2-days (Interquartile range [IQR] 1-4days), at which point most patients (82%) were provided with eTNTS-specific discharge instructions. First postoperative visit took place 9-days after discharge (IQR 7-10days). Within that time, 54% of patients made/sent at least one phone call or electronic message and 17% presented to the ED. Most common reasons for call/message were nasal care, appointment scheduling, symptom and medication questions. Conclusions: Through this work, we highlight the most common reasons for resource utilization via patient phone calls, messages, and ED visits among our cohort to better understand any shortfall or gap in the discharge process that may reduce these events.

Quality Improvement in Otologic Surgery Postoperative Instructions

OBJECTIVE

To examine and improve patient satisfaction with otologic surgery postoperative instructions.

STUDY DESIGN

Patients undergoing outpatient otologic surgery were compared over two different time periods, before (phase 1) and after (phase 2) modifying postoperative instructions. Key-informant interviews were conducted by phone on postoperative day 7. All patient-initiated communications after surgery were documented.

SETTING

Tertiary, academic hospital.

PATIENTS

Patients undergoing outpatient otologic surgery.

INTERVENTIONS

Otologic surgery.

MAIN OUTCOME MEASURES

Satisfaction ratings of different postoperative instruction categories (1-10, completely useless to perfectly helpful), including wound care, pain medication, non-pain medication, showering and bathing, activity restrictions, diet restrictions, follow-up appointment, and contact for questions; comments/critiques from patients; and patient-initiated communications.

RESULTS

Seventy eight patients were included in phase 1 and 52 in phase 2. Patient characteristics and distribution of surgeries were similar between phases. Rating for instructions were high in both phases (phase 1: 8.98[1.50], phase 2: 9.27[1.04], d = 0.216 [-0.271, 0.698]). More patients in phase 2 thought the instructions were adequate and clear (80.0% versus 55.6% in phase 1, d = 0.641 [0.011, 1.271]), and there were fewer critiques per patient (0.09 versus 0.15, d = -0.537 [-1.034, -0.040]) compared with phase 1. There was a shift in phase 2 communications away from wound care questions (17.5% versus 38.9%, d = -0.606 [-1.112, -0.099]) toward questions regarding medications (27.5% versus 6.7%, d = 0.921 [0.325, 1.516]).

CONCLUSION

An evidence-based postoperative instructions template led to more patients believing that the instructions were clear, fewer critiques being given, and a shift toward more actionable questions rather than those with answers already addressed in written instructions.

Effectiveness of Lifestyle Modification Education on Knowledge, Anxiety, and Postoperative Problems of Patients With Benign Perianal Diseases

PURPOSE

The aim of this study was to evaluate the effectiveness of preoperative planned education about lifestyle modifications on knowledge, anxiety level, and postoperative problems of the patients with benign perianal disease.

DESIGN

The study was a quasi-experimental design.

METHODS

The sample was a total of 102 patients undergoing surgical procedure for hemorrhoid and fissure in the general surgery unit of a state hospital in Turkey. Data were collected using the Descriptive Characteristics Determination Questionnaire, the Knowledge Determination Questionnaire, the Postoperative Problems Determination Questionnaire, and the State and Trait Anxiety Inventory.

FINDINGS

Preoperative written and verbal planned education about lifestyle modifications improved knowledge and decreased anxiety levels of the patients. There were no statistically significant differences between the control and study groups in postoperative problems other than leakage.

CONCLUSIONS

Results of the present study showed that nurse-conducted education on lifestyle modification of hemorrhoid and fissure was effective.

The automated patient discharge summary: improving communication at transfers of care after completion of radiotherapy

Aim

To develop an auto-generated patient discharge summary for all patients being treated in the Radiation Therapy Department.

Materials and methods

A patient discharge summary was developed using auto-generated data for all patients being treated in the Radiation Therapy Department. This ensures information relevant to the care of the patient is communicated effectively during transitions of care following radiation treatment, and provides a record of the treatment site(s), dose delivered, start/completion dates and contact information for Radiation Oncologists. The eScribe feature in MosaiQTM is utilised to auto-generate the patient discharge summary in less than one minute, and then printed and given to patients on the last day of treatment. This was piloted with palliative radiotherapy patients (n=22), who also completed a telephone survey.

Results

Results revealed patients had passed this document onto other healthcare providers and appreciated having a record of their treatments. Feedback was obtained from radiation therapy staff and the Patient and Family Advisory Committee. Subsequently, the language of the patient discharge summary was simplified and a disclaimer was added, indicating the document is not a complete radiation therapy treatment record. This initiative was then rolled out to all radiotherapy patients.

Findings

Overall, the patient discharge summary allows for a quick, automated and standardised approach for transfer of information during care transitions without significant impact to the Radiation Therapy Departmental workflow.

Enhanced communication performance improvement and patient satisfaction in an endoscopy/ambulatory surgery unit

A nursing incentive directed toward enhanced communication, performance improvement, patient safety, and patient satisfaction was initiated by the staff nurses in an endoscopy unit of a 714-bed specialized teaching hospital. Data were collected from approximately 1,800 ambulatory patients using a hands-off communication tool. The population was evenly divided between males and females. The goals of the data collection focused on the utilization of a medical questionnaire given to patients prior to elective procedures. The purpose of this initial study was to ascertain whether the questionnaires contributed to patients' communication regarding their health record while facilitating the admission/assessment phase of undergoing an elective endoscopy procedure. The medical questionnaire also served as a patient education tool whereby staff promoted the importance of safe medication administration. The initiative will remain ongoing and future studies will monitor and identify areas needed for performance improvement, patient safety, and enhanced communication. Patient satisfaction is measured using Press Ganey results.

The Impact of Revised Discharge Instructions on Patient Satisfaction

Introduction:

The impact of discharge instructions on a patient’s experience is not fully understood. This research explored whether nurse- and physician-generated discharge instructions had a positive effect on patient perceptions regarding their discharge experience.

Methods:

We compared Press Ganey discharge-related patient satisfaction scores for the year prior to and the year subsequent to implementing revised discharge instructions for all patients admitted to a 180-bed community-based hospital.

Results:

Following the implementation of our revised discharge instructions, patient satisfaction significantly improved (84.7% vs 83%, P < .01). Patients responded that they felt ready for discharge (86.6% vs 84.9%, P = .01) and were satisfied with instructions for home care (87.8% vs 85.3%, P < .01).

Discussion:

This study finds that a novel discharge instruction set produced by both the nursing and physician staff may improve patient perceptions with the discharge process.

Automated pictographic illustration of discharge instructions with Glyph: impact on patient recall and satisfaction

OBJECTIVES

First, to evaluate the effect of standard vs pictograph-enhanced discharge instructions on patients' immediate and delayed recall of and satisfaction with their discharge instructions. Second, to evaluate the effect of automated pictograph enhancement on patient satisfaction with their discharge instructions.

MATERIALS AND METHODS

Glyph, an automated healthcare informatics system, was used to automatically enhance patient discharge instructions with pictographs. Glyph was developed at the University of Utah by our research team. Patients in a cardiovascular medical unit were randomized to receive pictograph-enhanced or standard discharge instructions. Measures of immediate and delayed recall and satisfaction with discharge instructions were compared between two randomized groups: pictograph (n = 71) and standard (n = 73).

RESULTS

Study participants who received pictograph-enhanced discharge instructions recalled 35% more of their instructions at discharge than those who received standard discharge instructions. The ratio of instructions at discharge was: standard = 0.04 ± 0.03 and pictograph-enhanced = 0.06 ± 0.03. The ratio of instructions at 1 week post discharge was: standard = 0.04 ± 0.02 and pictograph-enhanced 0.04 ± 0.02. Additionally, study participants who received pictograph-enhanced discharge instructions were more satisfied with the understandability of their instructions at 1 week post-discharge than those who received standard discharge instructions.

DISCUSSION

Pictograph-enhanced discharge instructions have the potential to increase patient understanding of and satisfaction with discharge instructions.

CONCLUSION

It is feasible to automatically illustrate discharge instructions and provide them to patients in a timely manner without interfering with clinical work. Illustrations in discharge instructions were found to improve patients' short-term recall of discharge instructions and delayed satisfaction (1-week post hospitalization) with the instructions. Therefore, it is likely that patients' understanding of and interaction with their discharge instructions is improved by the addition of illustrations.

Scalable, sustainable cost-effective surgical care: a model for safety and quality in the developing world, part II: program development and quality care

BACKGROUND

The Guwahati Comprehensive Cleft Care Center (GCCCC) is committed to free medical and surgical care to patients afflicted with facial deformities in Assam, India. A needs-based approach was utilized to assemble numerous teams, processes of care, and systems aimed at providing world-class care to the most needy of patients, and to assist them with breaking through the barriers that prohibit them from obtaining services.

METHODS

A team of international professionals from various disciplines served in Guwahati full time to implement and oversee patient care and training of local counterparts. Recruitment of local professionals in all disciplines began early in the scheme of the program and led to gradual expansion of all medical teams. Emphasis was placed on achieving optimal outcome for each patient treated, as opposed to treating the maximum number of patients.

RESULTS

The center is open year round to offer full-time services and follow-up care. Along with surgery, GCCCC provides speech therapy, child life counseling, dental care, otolaryngology, orthodontics, and nutrition services for the cleft patients under one roof. Local medical providers participated in a model of graded responsibility commiserate with individualized skill and progress, and gradually assumed all leadership positions and now account for 92% of the workforce. Institutional infrastructure improvements positioned and empowered teams of skilled local providers while implementing systemized perioperative processes.

CONCLUSION

This needs-based approach to program development in Guwahati was successful in optimization of quality and safety in all clinical divisions.

Role of Postoperative Antimicrobials in Cleft Palate Surgery: Prospective, Double-Blind, Randomized, Placebo-Controlled Clinical Study in India

BACKGROUND

The purpose of this study was to determine whether administration of postoperative antibiotics affects the incidence of complications after primary cleft palate repair in a developing area.

METHODS

This study was a prospective, double-blind, randomized, placebo-controlled trial composed of 518 consecutive patients who underwent primary cleft palate repair at a single institution. Patients were aged 1 to 43 years at the time of surgery (median, 9 years). The patients were divided randomly into two groups. One group received a 5-day regimen of oral amoxicillin (50 mg/kg/day) postoperatively and the other group received placebo medication. Both groups received a single dose of cefuroxime (30 mg/kg) before incision. Patients and providers were blinded to the randomization. Patients were followed postoperatively for early complications (infection and wound breakdown) and for late complications (palatal fistulas).

RESULTS

The incidence of early complications was 13.8 percent among the patients in the placebo group and 8.7 percent among the patients in the antibiotic group (p = 0.175). Fistulas were noted in 17.1 percent in the placebo group and in 10.7 percent in the antibiotic group (p = 0.085). Logistic regression analysis identified visiting surgeons as the only covariate related to early complications (OR, 3.71; p < 0.001). However, the use of placebo (OR, 2.09; p = 0.037), female sex (OR, 2.04; p = 0.047), and Veau III and IV (OR, 3.31; p = 0.004) were observed as factors associated with the incidence of fistulas.

CONCLUSION

The authors' results indicate that postoperative antibiotic prophylaxis can reduce the incidence of fistulas after primary cleft palate repair in a developing area.

An audit of pain management following pediatric day surgery at British Columbia Children's Hospital

A prospective audit of 225 children was conducted to evaluate current pain management strategies both in-hospital and at home following day surgery at British Columbia Children's Hospital (Vancouver, British Columbia). Anesthetic, postanesthetic care unit and surgical day care unit records were collected to generate in-hospital data. A telephone questionnaire was administered 48 h postdischarge for at home data. Pain reports and scores were significantly higher (P<0.01) at home compared with in-hospital. Children undergoing certain procedures were more likely to experience significant pain. Although good pain control was commonly achieved after surgery, improvements may be possible by increasing the use of multimodal analgesia, providing standardized written discharge instructions and using surgery-specific pediatric analgesia guidelines.