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Huang T, Safranek C, Socrates V, Chartash D, Wright D, Dilip M, Sangal RB, Taylor RA. Patient-Representing Population's Perceptions of GPT-Generated Versus Standard Emergency Department Discharge Instructions: Randomized Blind Survey Assessment. J Med Internet Res 2024; 26:e60336. [PMID: 39094112 DOI: 10.2196/60336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 06/07/2024] [Accepted: 06/22/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND Discharge instructions are a key form of documentation and patient communication in the time of transition from the emergency department (ED) to home. Discharge instructions are time-consuming and often underprioritized, especially in the ED, leading to discharge delays and possibly impersonal patient instructions. Generative artificial intelligence and large language models (LLMs) offer promising methods of creating high-quality and personalized discharge instructions; however, there exists a gap in understanding patient perspectives of LLM-generated discharge instructions. OBJECTIVE We aimed to assess the use of LLMs such as ChatGPT in synthesizing accurate and patient-accessible discharge instructions in the ED. METHODS We synthesized 5 unique, fictional ED encounters to emulate real ED encounters that included a diverse set of clinician history, physical notes, and nursing notes. These were passed to GPT-4 in Azure OpenAI Service (Microsoft) to generate LLM-generated discharge instructions. Standard discharge instructions were also generated for each of the 5 unique ED encounters. All GPT-generated and standard discharge instructions were then formatted into standardized after-visit summary documents. These after-visit summaries containing either GPT-generated or standard discharge instructions were randomly and blindly administered to Amazon MTurk respondents representing patient populations through Amazon MTurk Survey Distribution. Discharge instructions were assessed based on metrics of interpretability of significance, understandability, and satisfaction. RESULTS Our findings revealed that survey respondents' perspectives regarding GPT-generated and standard discharge instructions were significantly (P=.01) more favorable toward GPT-generated return precautions, and all other sections were considered noninferior to standard discharge instructions. Of the 156 survey respondents, GPT-generated discharge instructions were assigned favorable ratings, "agree" and "strongly agree," more frequently along the metric of interpretability of significance in discharge instruction subsections regarding diagnosis, procedures, treatment, post-ED medications or any changes to medications, and return precautions. Survey respondents found GPT-generated instructions to be more understandable when rating procedures, treatment, post-ED medications or medication changes, post-ED follow-up, and return precautions. Satisfaction with GPT-generated discharge instruction subsections was the most favorable in procedures, treatment, post-ED medications or medication changes, and return precautions. Wilcoxon rank-sum test of Likert responses revealed significant differences (P=.01) in the interpretability of significant return precautions in GPT-generated discharge instructions compared to standard discharge instructions but not for other evaluation metrics and discharge instruction subsections. CONCLUSIONS This study demonstrates the potential for LLMs such as ChatGPT to act as a method of augmenting current documentation workflows in the ED to reduce the documentation burden of physicians. The ability of LLMs to provide tailored instructions for patients by improving readability and making instructions more applicable to patients could improve upon the methods of communication that currently exist.
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Affiliation(s)
- Thomas Huang
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, United States
- Department for Biomedical Informatics and Data Science, Yale School of Medicine, New Haven, CT, United States
| | - Conrad Safranek
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, United States
- Department for Biomedical Informatics and Data Science, Yale School of Medicine, New Haven, CT, United States
| | - Vimig Socrates
- Department for Biomedical Informatics and Data Science, Yale School of Medicine, New Haven, CT, United States
- Program of Computational Biology and Bioinformatics, Yale University, New Haven, CT, United States
| | - David Chartash
- Department for Biomedical Informatics and Data Science, Yale School of Medicine, New Haven, CT, United States
- School of Medicine, University College Dublin, National University of Ireland, Dublin, Ireland
| | - Donald Wright
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, United States
- Department for Biomedical Informatics and Data Science, Yale School of Medicine, New Haven, CT, United States
| | - Monisha Dilip
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Rohit B Sangal
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Richard Andrew Taylor
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, United States
- Department for Biomedical Informatics and Data Science, Yale School of Medicine, New Haven, CT, United States
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Carey A, Starkweather A, Bai A, Horgas A, Cho H, Beneciuk JM. Emergency Department Discharge Teaching Interventions: A Scoping Review. J Emerg Nurs 2024; 50:444-462. [PMID: 38323972 DOI: 10.1016/j.jen.2023.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 12/17/2023] [Accepted: 12/24/2023] [Indexed: 02/08/2024]
Abstract
INTRODUCTION Emergency department discharge education is intended to provide patients with information to self-manage their condition or injury, identify potential complications, and follow-up or referral. However, most patients cannot recall the discharge information provided, leading to adverse clinical outcomes, return visits, and higher costs. A scoping review was undertaken to explore discharge education interventions that have been studied in the emergency department setting and outcomes that have been used to evaluate the effectiveness of the interventions. METHODS A literature review was conducted using the databases PubMed/Medline, Cumulative Index to Nursing and Allied Health Literature, and Education Resources Information Center, with search terms focused on emergency nursing and patient discharge education interventions. RESULTS Of the publications identified, 18 studies met the inclusion criteria. There was variation among studies on the conditions/injuries and populations of focus for the intervention. The interventions were categorized by learning styles, including auditory (n=10), kinesthetic (n=1), visual (n=15), reading/writing (n=1), and multimodal (n=7). Outcomes evaluated included those that were patient-specific (education, self-management, clinical, and adherence) and metrics of the health system and public health. DISCUSSION Multimodal discharge education that addresses various learning styles and levels of health literacy improved patient education, self-management, and clinical outcomes. Additional support and reminders improved patient adherence. Identified gaps included limited kinesthetic interventions and culturally tailored education. Translational science for advancing sustainable interventions in clinical practice is needed to enhance the emergency department discharge process and patient, system, and public health outcomes.
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Shen D, Huang W, Wei S, Zhu Y, Shi B. The impact of Teach-back method on preoperative anxiety and surgical cooperation in elderly patients undergoing outpatient ophthalmology surgery: A randomized clinical trial. Medicine (Baltimore) 2023; 102:e32931. [PMID: 36827029 DOI: 10.1097/md.0000000000032931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND The literatures have demonstrated that Teach-back method is an effective communication tool to understand health education, especially in the elderly patients. However, there is limited research of Teach-back method in preoperative education for outpatient surgical patients. This study was conducted to investigate the effects of the Teach-back method on preoperative anxiety and surgical cooperation in elderly patients undergoing outpatient ophthalmology surgery. METHODS One hundred sixteen elderly patients who underwent outpatient ophthalmology surgery were selected as the research objects. They were divided into the observation group (58 cases) and the control group (58 cases). The Teach-back preoperative education was adopted in the observation group and the standard preoperative education method was adopted in the control group. The degree of anxiety, surgical cooperation, and awareness of health knowledge were compared between the 2 groups, and the variations of blood pressure and heart rate, as well as the highest values of intraoperative blood pressure and heart rate before and after method, were recorded and compared. RESULTS The preoperative systolic blood pressure in the observation group was significantly lower than that in the control group. The intraoperative (the highest value) heart rate, systolic blood pressure, and diastolic blood pressure in the observation group were lower than those in the control group, and the differences were statistically significant (P < .05). After intervention, the anxiety score and information demand score of the observation group were lower than those of the control group, and the differences were statistically significant (P < .05). The degree of surgery cooperation and awareness of perioperative health knowledge in the observation group were all higher than those in the control group; the differences were statistically significant (P < .05). CONCLUSION The Teach-back method could relieve the preoperative anxiety of the patients, improve the quality of patients surgery cooperation, and facilitate the awareness of health knowledge. Moreover, it could effectively improve the intraoperative stress response of the elderly patients and reduce the large fluctuations of blood pressure and heart rate.
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Affiliation(s)
- Dan Shen
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Weiyi Huang
- Outpatient Operating Room, Tianjin Eye Hospital, Tianjin, China
| | - Shujin Wei
- Outpatient Operating Room, Tianjin Eye Hospital, Tianjin, China
| | - Yanjun Zhu
- Outpatient Operating Room, Tianjin Eye Hospital, Tianjin, China
| | - Baoxin Shi
- School of Nursing, Tianjin Medical University, Tianjin, China
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Iyeke LO, Razack B, Richman M, Berman AJ, Davis F, Willis H, Gizzi-Murphy M, Guilherme S, Johnson S, Njoku C, Ramjattan G, Krol K, Kwon N. Novel Discharge Center for Transition of Care in Vulnerable Emergency Department Treat and Release Patients. Cureus 2023; 15:e34937. [PMID: 36938288 PMCID: PMC10017056 DOI: 10.7759/cureus.34937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2023] [Indexed: 02/15/2023] Open
Abstract
Introduction The majority of emergency department (ED) patients are discharged following evaluation and treatment. Most patients are recommended to follow up with a primary care provider (PCP) or specialist. However, there is considerable variation between providers and EDs in discharge process practices that might facilitate such follow-up (e.g., simply discharging patients with follow-up physician names/contact information vs. making appointments for patients). Patients who do not follow up with their PCPs or specialists are more likely to be readmitted within 30 days than those who do. Furthermore, vulnerable patients have difficulty arranging transitional care appointments due to poor health literacy, inadequate insurance, appointment availability, and self-efficacy. Our innovative ED discharge process utilizes an Emergency Department Discharge Center (EDDC) staffed by ED Care Coordinators and assists patients with scheduling post-discharge appointments to improve rates of follow-up with outpatient providers. This study describes the structure and activities of the EDDC, characterizes the EDDC patient population, and demonstrates the volume and specialties of appointments scheduled by EDDC Care Coordinators. The impact of the EDDC on operational metrics (72-hour returns, 30-day admissions, and length-of-stay [LOS]) and the impact of the EDDC on patient satisfaction are evaluated. Methods The Long Island Jewish Medical Center (LIJMC) EDDC is an intervention developed in July 2020 within a 583-bed urban hospital serving a racially, ethnically, and socio-economically diverse population, with many patients having limited access to healthcare. Data from the Emergency Medicine Service Line (EMSL), an ED Care Coordinator database, and manual chart review were collected from July 2020 to July 2021 to examine the impact of the EDDC on 72-hour returns, 30-day admissions, and Press Ganey's® "likelihood to recommend ED" score (a widely used patient satisfaction survey question). The EDDC pilot cohort was compared to non-EDDC discharged patients during the same period. Results In unadjusted analysis, EDDC patients were moderately less likely to return to the ED within 72 hours (5.3% vs. 6.5%; p = 0.0044) or be admitted within 30 days (3.4% vs. 4.2%). The program was particularly beneficial for uninsured and elderly patients. For both EDDC and non-EDDC patients, most revisits and 30-day admissions were for the same chief complaint as the index visit. The length-of-stay increased by ~10 minutes with no impact on satisfaction with ED visits. Musculoskeletal conditions (~20%) and specialties (~15%) were the most commonly represented. Approximately 10% of referrals were to obtain a PCP. Nearly 90% were to new providers or specialties. Most scheduled appointments occurred within a week. Conclusion This novel EDDC program, developed to facilitate outpatient follow-up for discharged ED patients, produced a modest but statistically significant difference in 72-hour returns and 30-day admissions for patients with EDDC-scheduled appointments vs. those referred to outpatient providers using the standard discharge process. ED LOS increased by ~10 minutes for EDDC vs. non-EDDC patients, with no difference in satisfaction. Future analyses will investigate impacts on 72-hour returns, 30-day admissions, LOS, and satisfaction after adjusting for characteristics such as age, insurance, having a PCP, and whether the scheduled appointment was attended.
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Affiliation(s)
- Lisa O Iyeke
- Emergency Medicine, Long Island Jewish Medical Center, New Hyde Park, USA
| | - Bibi Razack
- Emergency Medicine, Long Island Jewish Medical Center, New Hyde Park, USA
| | - Mark Richman
- Emergency Medicine, Long Island Jewish Medical Center, New Hyde Park, USA
| | - Adam J Berman
- Medical Toxicology, Long Island Jewish Medical Center, New Hyde Park, USA
| | - Frederick Davis
- Emergency Medicine, Long Island Jewish Medical Center, New Hyde Park, USA
| | - Helena Willis
- Emergency Medicine, Long Island Jewish Medical Center, New Hyde Park, USA
| | | | - Stephen Guilherme
- Emergency Medicine, Long Island Jewish Medical Center, New Hyde Park, USA
| | - Sarah Johnson
- Emergency Medicine, Long Island Jewish Medical Center, New Hyde Park, USA
| | - Chinna Njoku
- Emergency Medicine, Long Island Jewish Medical Center, New Hyde Park, USA
| | - Genelle Ramjattan
- Emergency Medicine, Long Island Jewish Medical Center, New Hyde Park, USA
| | - Katarzyna Krol
- Emergency Medicine, Long Island Jewish Medical Center, New Hyde Park, USA
| | - Nancy Kwon
- Emergency Medicine, Long Island Jewish Medical Center, New Hyde Park, USA
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Sleiman AA, Gravina NE, Portillo D. An evaluation of the teach-back method for training new skills. J Appl Behav Anal 2023; 56:117-130. [PMID: 36454877 DOI: 10.1002/jaba.966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 11/16/2022] [Indexed: 12/03/2022]
Abstract
There are several effective training packages (e.g., behavioral skills training, video modeling, and self-instruction packages) available to train staff. Despite their efficacy, these training procedures require substantial time or preplanning and resources to create materials. Teach-back, an empirically validated method used in the healthcare setting to enhance communication between clinicians and patients, does not require any preplanning or materials. However, this method has yet to be investigated in the context of training and supervision. The purpose of this experiment was to evaluate the efficacy of teach-back in training participants to implement preference assessments and a token economy. The teach-back method improved procedural integrity to at least 88%, and the addition of vocal-verbal feedback resulted in all participants achieving 100% integrity in all skills. We discuss the implications of these findings.
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Cook JLE, Fioratou E, Davey P, Urquhart L. Improving patient understanding on discharge from the short stay unit: an integrated human factors and quality improvement approach. BMJ Open Qual 2022; 11:bmjoq-2021-001810. [PMID: 35998981 PMCID: PMC9403153 DOI: 10.1136/bmjoq-2021-001810] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 08/08/2022] [Indexed: 11/28/2022] Open
Abstract
This intervention used a systems approach to improve patient understanding on discharge from the adult acute medicine short stay unit (SSU). Patient understanding was assessed across five domains: diagnosis, medication changes, follow-up care, return instructions and knowing who their consultant was. The aim of this approach was that at least 90% of patients achieved near-complete understanding (score >4) on questionnaire across all five discharge domains by the end of April 2021. Pre-intervention most patients received verbal instructions and only a minority received written information. Through staff interviews, we identified the electronic discharge document (EDD) as a practical source of written information. However, testing with patients showed that the format required substantial redesign to be written in patient-friendly language, using signposting, spacing information out and avoiding jargon. The effect of this intervention was assessed with a structured telephone questionnaire, which included both a patient self-rated score and a comparative understanding score to assess true patient understanding of the revised EDD. Pre-intervention 29 discharged patients were interviewed across 10 days and post-intervention 10 patients were interviewed in 7 days. Patients consistently over-rated their understanding of discharge information. Only one patient achieved the aim of comparative understanding >4 across all domains post-intervention. Understanding improved across all but one of the domains, the exception being medication changes. An important unanticipated consequence was that interviews identified inconsistencies in EDD information and gaps in patient understanding, which required escalation to the SSU team. In summary, this intervention improved patient understanding across four of the five domains. However, further work is required on process reliability for the redesigned EDD and on improving understanding of medication changes. Furthermore, the interviews revealed clinically important inconsistencies in EDD information and gaps in patient understanding.
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Affiliation(s)
| | | | - Peter Davey
- University of Dundee School of Medicine, Dundee, UK
| | - Lynn Urquhart
- Infectious Diseases and Acute Medicine, NHS Tayside, Dundee, UK
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McWhirter L, Lou Y, Reingold S, Warsh S, Thomas-Gale T, Haynes C, Rinehart D, Wendel KA, Frost HM. Rates of Appropriate Treatment and Follow-Up Testing After a Gonorrhea and/or Chlamydia Infection in an Urban Network of Federally Qualified Health Center Systems. Sex Transm Dis 2022; 49:319-324. [PMID: 35001017 PMCID: PMC9018487 DOI: 10.1097/olq.0000000000001600] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Reinfection and partner transmission are common with Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT). We assessed treatment and follow-up laboratory testing for GC and CT and evaluated associations with patient- and system-level factors. METHODS The analysis included positive GC and/or CT nucleic acid amplification test results from patients aged 14 to 24 years at a federally qualified health center system site in Denver, CO, from January 2018 to December 2019. Outcomes assessed include treatment within 14 days, HIV/syphilis testing within 6 months, and repeat GC and CT testing within 2 to 6 months. Bivariate and multivariable regression modeling assessed associated factors. RESULTS Among 27,168 GC/CT nucleic acid amplification tests performed, 1.8% (484) were positive for GC and 7.8% (2125) were positive for CT. Within the assessed time frames, 87% (2275) of patients were treated, 54.1% (1411) had HIV testing, 50.1% (1306) had syphilis testing, and 39.9% (1040) had GC and CT retesting. Older patients were more likely to receive treatment (adjusted odds ratio 1.13; 95% confidence interval, 1.00-1.27; P = 0.05) than younger patients, whereas males were less likely to receive GC and CT retesting (adjusted odds ratio, 0.19; 95% confidence interval, 0.11-0.33; P < 0.001) than females. Patients treated on the day of testing were less likely to receive follow-up laboratory tests than those treated 2 to 14 days after. CONCLUSIONS Although most patients received antibiotic treatment, only about half received HIV/syphilis testing and less than half received GC and CT retesting. It is critical to find innovative strategies to improve treatment and follow-up management of these infections to decrease complications, reduce transmission, and combat the rising rates of sexually transmitted infections.
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Affiliation(s)
| | - Yingbo Lou
- Denver Health Medical Center, Community Health Services, Denver, CO
| | - Sarah Reingold
- University of Colorado School of Medicine, Department of Internal Medicine-Pediatrics, Aurora, CO
| | - Sarah Warsh
- Denver Health Medical Center, Community Health Services, Denver, CO
| | - Tara Thomas-Gale
- Denver Health Medical Center, Community Health Services, Denver, CO
| | - Christine Haynes
- Denver Health Medical Center, Department of Internal Medicine, Denver, CO
- University of Colorado School of Medicine, Department of Medicine, Division of General Internal Medicine, Aurora, CO
| | | | - Karen A. Wendel
- Denver Health Medical Center, Department of Internal Medicine, Division of Infectious Diseases, Denver, CO
- University of Colorado School of Medicine, Department of Internal Medicine, Division of Infectious Diseases, Aurora, CO
| | - Holly M Frost
- Denver Health Medical Center, Office of Research, Denver, CO
- Denver Health Medical Center, Department of Pediatrics, Denver, CO
- University of Colorado School of Medicine, Department of Pediatrics, Aurora, CO
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Abuaish M, Mirza G, Al-Zamzami W, Atiyah M. The Effect of a Structured Gastroenteritis Discharge Management Plan on Compliance, Prognosis, and Parents' Satisfaction. Cureus 2022; 14:e23240. [PMID: 35449640 PMCID: PMC9012551 DOI: 10.7759/cureus.23240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2022] [Indexed: 12/05/2022] Open
Abstract
Background: Acute gastroenteritis is one of the most common causes of dehydration in children. Parents’ education is an essential part of its management. In this study, we assessed the efficacy of discharge instructions in the pediatric emergency department for parents of children with acute gastroenteritis, together with disease prognosis and parents’ satisfaction. Methods: An observational prospective cohort study was conducted among parents of children with acute gastroenteritis, with mild-to-moderate dehydration, who presented to the pediatric emergency room from March 2018 to July 2018. Parents were interviewed upon their child’s presentation and in follow-up phone calls after one week to assess the parents’ knowledge and the disease’s prognosis. Results: There were a total of 218 parents of children with acute gastroenteritis of mild and moderate dehydration. The mean age was four years and one month ± three years and seven months. Forty-four percent of study participants had reasonable awareness of their child’s condition, and most patients (86%) improved fully. The exact adherence to instructions was 54%, the proportion of children who returned to the emergency department was 13%, and parental satisfaction and appreciation of the provided education was 98%. Conclusion: In the study group, not strictly following fluid rehydration plans in discharge instructions did not negatively affect the course of improvement. This indicates that simple instructions to rehydrate with any fluid a child might accept and give clear red flags for observation are likely to be enough to treat gastroenteritis of mild-to-moderate severity.
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McFadden NR, Gosdin MM, Jurkovich GJ, Utter GH. Patient and clinician perceptions of the trauma and acute care surgery hospitalization discharge transition of care: a qualitative study. Trauma Surg Acute Care Open 2022; 7:e000800. [PMID: 35128068 PMCID: PMC8772453 DOI: 10.1136/tsaco-2021-000800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 10/08/2021] [Indexed: 11/17/2022] Open
Abstract
Objectives Trauma and acute care surgery (TACS) patients face complex barriers associated with hospitalization discharge that hinder successful recovery. We sought to better understand the challenges in the discharge transition of care, which might suggest interventions that would optimize it. Methods We conducted a qualitative study of patient and clinician perceptions about the hospital discharge process at an urban level 1 trauma center. We performed semi-structured interviews that we recorded, transcribed, coded both deductively and inductively, and analyzed thematically. We enrolled patients and clinicians until we achieved data saturation. Results We interviewed 10 patients and 10 clinicians. Most patients (70%) were male, and the mean age was 57±16 years. Clinicians included attending surgeons, residents, nurse practitioners, nurses, and case managers. Three themes emerged. (1) Communication (patient-clinician and clinician-clinician): clinicians understood that the discharge process malfunctions when communication with patients is not clear. Many patients discussed confusion about their discharge plan. Clinicians lamented that poorly written discharge summaries are an inadequate means of communication between inpatient and outpatient clinicians. (2) Discharge teaching and written instructions: patients appreciated discharge teaching but found written discharge instructions to be overwhelming and unhelpful. Clinicians preferred spending more time teaching patients and understood that written instructions contain too much jargon. (3) Outpatient care coordination: patients and clinicians identified difficulties with coordinating ongoing outpatient care. Both identified the patient’s primary care physician and insurance coverage as important determinants of the outpatient experience. Conclusion TACS patients face numerous challenges at hospitalization discharge. Clinicians struggle to effectively help their patients with this stressful transition. Future interventions should focus on improving communication with patients, active communication with a patient’s primary care physician, repurposing, and standardizing the discharge summary to serve primarily as a means of care coordination, and assisting the patient with navigating the transition. Level of evidence III—descriptive, exploratory study.
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Affiliation(s)
- Nikia R McFadden
- Department of Surgery, Division of Trauma, Acute Care Surgery, and Surgical Critical Care, University of California Davis, Davis, California, USA
| | - Melissa M Gosdin
- Center for Healthcare Policy and Research, University of California Davis, Davis, California, USA
| | - Gregory J Jurkovich
- Department of Surgery, Division of Trauma, Acute Care Surgery, and Surgical Critical Care, University of California Davis, Davis, California, USA
- Department of Surgery Outcomes Research Group, University of California Davis, Davis, California, USA
| | - Garth H Utter
- Department of Surgery, Division of Trauma, Acute Care Surgery, and Surgical Critical Care, University of California Davis, Davis, California, USA
- Center for Healthcare Policy and Research, University of California Davis, Davis, California, USA
- Department of Surgery Outcomes Research Group, University of California Davis, Davis, California, USA
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Winokur EJ. Optimizing Discharge Knowledge and Behaviors. J Emerg Nurs 2021; 47:839-842. [PMID: 34776092 DOI: 10.1016/j.jen.2021.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 09/01/2021] [Indexed: 10/19/2022]
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Hodges R, Stepien S, Kim LY. Quality Improvement: Using Teach-Back to Improve Patient Satisfaction during Discharge in the Emergency Department. J Emerg Nurs 2021; 47:870-878. [PMID: 34215436 DOI: 10.1016/j.jen.2021.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 05/12/2021] [Accepted: 05/18/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Patients discharged in the emergency department often have poor understanding of their discharge instructions. Teach-back is a communication method that involves asking patients to explain in their own words what a health care provider just told them. The purpose of this project was to determine whether nurse-led teach-back at discharge could improve patient satisfaction with discharge information. METHODS A teach-back method was used to educate patients on what to do if they do not feel better after leaving, using a single site quality improvement design. Patient satisfaction was measured using a standardized benchmark question on whether providers explained what to do if they did not feel better after leaving. The department goal for this question was established as achieving a response of "Yes, definitely" for 64.4% or more of the satisfaction surveys. Patient satisfaction data were collected before and after intervention through a survey given to patients within 24 hours after their visit. A statistical process chart was used to analyze whether the observed improvements coincided with implementation of the teach-back intervention. RESULTS Although there was an overall increase in post-intervention scores (61%) from baseline scores (59%), there were no special cause variations signaling that the intervention had a significant impact. DISCUSSION Teach-back may improve patient satisfaction with discharge information. Future implementation with measures of intervention adoption, fidelity, accountability, and sustainability are needed.
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Chodosh J, Goldfeld K, Weinstein BE, Radcliffe K, Burlingame M, Dickson V, Grudzen C, Sherman S, Smilowitz J, Blustein J. The HEAR-VA Pilot Study: Hearing Assistance Provided to Older Adults in the Emergency Department. J Am Geriatr Soc 2021; 69:1071-1078. [PMID: 33576037 DOI: 10.1111/jgs.17037] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/23/2020] [Accepted: 12/28/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND/OBJECTIVES Poor communication is a barrier to care for people with hearing loss. We assessed the feasibility and potential benefit of providing a simple hearing assistance device during an emergency department (ED) visit, for people who reported difficulty hearing. DESIGN Randomized controlled pilot study. SETTING The ED of New York Harbor Manhattan Veterans Administration Medical Center. PARTICIPANTS One hundred and thirty-three Veterans aged 60 and older, presenting to the ED, likely to be discharged to home, who either (1) said that they had difficulty hearing, or (2) scored 10 or greater (range 0-40) on the Hearing Handicap Inventory-Survey (HHI-S). INTERVENTION Subjects were randomized (1:1), and intervention subjects received a personal amplifier (PA; Williams Sound Pocketalker 2.0) for use during their ED visit. MEASUREMENTS Three survey instruments: (1) six-item Hearing and Understanding Questionnaire (HUQ); (2) three-item Care Transitions Measure; and (3) three-item Patient Understanding of Discharge Information. Post-ED visit phone calls to assess ED returns. RESULTS Of the 133 subjects, 98.3% were male; mean age was 76.4 years (standard deviation (SD) = 9.2). Mean HHI-S score was 19.2 (SD = 8.3). Across all HUQ items, intervention subjects reported better in-ED experience than controls. Seventy-five percent of intervention subjects agreed or strongly agreed that ability to understand what was said was without effort versus 56% for controls. Seventy-five percent of intervention subjects versus 36% of controls said clinicians provided them with an explanation about presenting problems. Three percent of intervention subjects had an ED revisit within 3 days compared with 9.0% controls. CONCLUSION Veterans with hearing difficulties reported improved in-ED experiences with use of PAs, and were less likely to return to the ED within 3 days. PAs may be an important adjunct to older patient ED care but require validation in a larger more definitive randomized controlled trial.
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Affiliation(s)
- Joshua Chodosh
- VA New York Harbor Healthcare System, New York, New York, USA.,Division of Geriatrics and Palliative Care, Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA.,Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Keith Goldfeld
- Division of Biostatistics, Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Barbara E Weinstein
- Division of Geriatrics and Palliative Care, Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA.,Audiology Program, Graduate Center, City University of New York, New York, New York, USA
| | - Kate Radcliffe
- VA New York Harbor Healthcare System, New York, New York, USA.,Division of Geriatrics and Palliative Care, Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | | | - Victoria Dickson
- Rory Meyers College of Nursing, New York University, New York, New York, USA
| | - Corita Grudzen
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA.,Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Scott Sherman
- VA New York Harbor Healthcare System, New York, New York, USA.,Division of Geriatrics and Palliative Care, Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA.,Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Jessica Smilowitz
- VA New York Harbor Healthcare System, New York, New York, USA.,Division of Geriatrics and Palliative Care, Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Jan Blustein
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA.,Robert F. Wagner Graduate School of Public Service, New York University, New York, New York, USA
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