We welcome Valley Health, headquartered in Winchester, VA, to the Discharge 1-2-3 user community. Valley Health just chose our content for their six emergency departments. Like many other discerning Epic users, Valley Health was dissatisfied with their existing content and chose to switch to Discharge 1-2-3.

Valley Health operates six hospitals: Winchester Medical Center, in Winchester, VA, Warren Memorial Hospital, in Front Royal, VA, Shenandoah Memorial Hospital in Woodstock, VA, Page Memorial Hospital in Luray, VA, Hampshire Memorial Hospital in Romney, WV, and War Memorial Hospital in Berkeley Springs, WV. Each year Valley Health discharges approximately 140,000 patients from their emergency departments.

At last week’s Essentials of EM Conference in San Francisco hosted by Mel Herbert, MD, Greg Henry, MD, past president of ACEP, gave the keynote address. He reminded us how important it is for discharge instructions to be concise. Then he asked his audience how many of them gave 10-page discharge instructions. When it became obvious that for many this was common practice, he challenged us to be brief by stating:

“The amount of discharge instructions the patient actually reads is inversely proportional to how long they are.”

Rick Bukata, MD, another leading Emergency Department clinician and educator, weighed in on the same theme last year. In his Emergency Physicians Monthly article “With Discharge Instructions, Less is More,” he questioned the merit of substituting quantity for quality. Specifically, he wrote:

“The trend of voluminous, exhaustive discharge instructions puts the pressure on patients to understand and identify complex risk factors, like infection. According to the research, this is probably a bad idea. . . . Some people seem to think that if discharge instructions are a good thing, then the more the better.”

Why aren’t discharge instructions more short and to the point? You’ve undoubtedly heard Mark Twain’s quote:

“I didn’t have time to write a short letter, so I wrote a long one instead.”

Concise discharge instructions are:

• More patient-specific
• More likely to be read by the patient
• Less likely to confuse the patient

And concise discharge instructions contribute to:

• Improved patient outcomes
• Increased patient satisfaction
• Better risk management

As several Emergency Department thought leaders have recently reminded us, discharge instructions need to be concise and to the point.

Are your discharge instructions short and sweet?

Chris Galassi, MD
CEO, Discharge 1-2-3

We welcome The University of Wisconsin Hospital and Clinics in Madison, WI, to the Discharge 1-2-3 user community. Like a number of other discerning Epic users, UW wasn’t satisfied with the quality of their existing ED content and chose to switch to Discharge 1-2-3.

We’re happy to share that the partnership is off to a great start and that initial feedback is very positive. ED physicians feel the content is better that what they previously had, and that the options are more specific, especially for peds. They really like the foreign language instructions. We’ve also received feedback and suggestions from the UW clinicians which is being incorporated into the content libraries as they are updated.

On Wisconsin!

Hugh Martin

Focused and aggressive best describe the tone of the Allscripts Client Experience 2013 (ACE13) conference at McCormick Place in Chicago two weeks ago. As a long-time Allscripts partner, Discharge 1-2-3 joined nearly 4,500 other clients, staff, partners, and industry representatives to share priorities, plans, and ideas for improving system performance and compliance. We came away impressed.

Allscripts President and CEO Paul Black laid out the firm’s five areas of primary focus during his address:

1. Meaningful Use Stage 2 compliance.
2. ICD-10 implementation.
3. Integration of solutions and data.
4. Making the next upgrade much stronger than the current version.
5. Innovation in all areas.

In addition to imparting new organizational goals, other major themes for the conference included population health, interoperability, and analytics. Keynote speakers Rasu Shrestha, MD, Vice President of Medical Information Technology at University of Pittsburgh Medical Center, and Vinay Vaidya, MD, Vice President and CMIO of Phoenix Children’s, shared examples of how their institutions were using data to improve consumer empowerment and patient safety, respectively.

“He who tames the data, wins,” said Dr Shrestha. We couldn’t agree more.

Hugh Martin

Last week Discharge 1-2-3 joined almost 1500 other attendees at the 2013 International MUSE (Medical Users Software Exchange) Conference in suburban Washington, DC. The annual MUSE conference, aka the Meditech users’ meeting, is a great opportunity for Meditech users to hear about what’s new from Meditech and other suppliers to the Meditech community and to exchange best practices. Discharge 1-2-3 provides discharge instructions and patient education to many Meditech hospitals, and it was great to see so many of our customers in one place.

With over 300 sessions and 175 exhibitors, it was impossible to experience everything, but here’s a list of some of our takeaways from this year’s MUSE:

• Users are starting to demand higher levels of functionality, and that discharge instructions and patient education be more patient-specific and user-friendly. A number of users expressed frustration that Meditech’s current ED Module/PDI can’t be customized at the patient level.
• Many Meditech hospitals are comfortable with interfaced solutions, and are unwilling to sacrifice functionality just to say they have a fully-integrated, house-wide solution.
• Although most hospitals (at least those in the US) expressed concern about meeting Meaningful Use criteria, we heard a grudging acknowledgement from some that MU was really an enabler that would help hospitals function at a new level in the future.
• There is increased interest in how discharge instructions and patient education can reduce readmissions, increase patient satisfaction, and automate compliance. Patient engagement is a term we’ll be hearing a lot more of in the future.

Those are some of our takeaways from MUSE. What did you learn? Feel free to share.

Hugh Martin
Discharge 1-2-3
hmartin@discharge123.com

A Case in point

Thanks to a recent trip to my local emergency room for upper respiratory problems, I experienced first-hand the crucial role that clear, personalized discharge instructions play in a patient’s recovery, as well as in the overall care experience. Upon arriving in ER late one night, my local hospital’s very personal, capable ER staff moved me from triage through diagnoses and treatment with efficiency and care. They swiftly relieved my pain and fear, running multiple tests and treating my issues with thorough professionalism and alacrity; in fact, I returned home to my own bed within 2.5 hours of departing for the hospital!

That’s when my grateful admiration turned to disappointment, coloring my entire view of my ER experience. My discharge instructions, an integral part of my recovery at home, proved to be quite long, vague at best, and not even specific to my case. I received ten pages of generic instructions that amounted to an automatic printout of garbled words, with no input from my diligent ER doctor. They did not even address me, but “you and your child.” Really? As the paying patient, I was offended by such carelessness, not to mention frustrated and confused by the instructions. They blatantly contradicted the “core measures” commitment printout that the hospital eagerly handed me earlier. Talk about disillusioning.

I had to call the hospital’s busy ER staff the next morning for clarification on my treatment. I took the opportunity to connect with the ED Director, relating how my wonderful patient experience was ruined by the substandard, generic discharge instruction. She shared with me that they didn’t get to consider or vote on their discharge instructions and that they were “just built in” to their EMR. ER departments across the country strive to deliver fast, accurate, compassionate care, while improving efficiency and patient/family satisfaction. Why ruin that effort with the one lasting imprint a patient takes home and relies upon?

MF, a patient who recently visited an emergency room in the Chicago area

A lot of nurses in leadership positions think their hospitals need to improve their discharge instructions. We had the pleasure of speaking with hundreds of nurses last week at the Emergency Nurses Association Leadership Conference 2013 in Fort Lauderdale. Most attendees were experienced emergency department nurses currently acting in managerial roles.

In general, the nurses we spoke with were not enthusiastic about their current discharge instructions. Specific complaints included:

• ED clinicians have less influence in the discharge instruction selection process than in the past. This is because many institutions are moving to enterprise solutions and the voice of the ED clinician is being heard too late in process if at all. This is a shame since EDs normally do more discharges than the rest of the hospital and they have a lot of good experience on this topic that could benefit the rest of the institution.
• Instructions are often too long and generic. A number commented that their discharge instructions included a lot of pages, but the information was not patient-specific. They doubted whether patients read it all or really understood what they were supposed to do.
• Many patients don’t understand the instructions as written. We frequently heard the complaint that instructions contain too much medical jargon. Much of the discharge instructions and patient information available is written to too high a reading level
• Instructions don’t fit the diagnosis title. Sometimes instructions don’t seem to fit the diagnosis, which creates confusion.
• Need more languages. Gone are the days when making instructions available in only English or Spanish was enough.
• General education is useful but instructions need to be more patient-specific.

The general consensus was that having good discharge instructions will become even more important in the future as hospitals continue to integrate their systems and as healthcare moves towards an accountable care model.

What do you think?

Hugh Martin
Discharge 1-2-3

Welcome to Discharge 1-2-3™s new blog. Our intent is to host a conversation on current topics related to patient discharge instructions and educational content. We want this blog to:

• Demonstrate how patient instructions and content contribute to improved outcomes;
• Showcase best practices in discharge instructions and patient educational content;
• Share insights from leading experts in the field.

We think these are important topics and hope you do too. As you probably know, Discharge 1-2-3 is a best of breed developer of software and content libraries for emergency, inpatient, and ambulatory settings. Over the past 10 years we have helped hospitals discharge an estimated 100 million patients. That experience, and the feedback from our customers, has convinced us that not all patient instructions are created equal.

We hope you find this blog useful, and invite you to participate. Here are some of the topics we plan to explore:

• With discharge instructions, less is more
• Risk management
• Patient instructions vs. patient education
• Relationship between discharge instructions and patient experience
• How to reduce barriers to communication

Are there others you would like to see? Please let us know.

Thanks,

Chris Galassi, MD, MS