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?