As hospitalists, our continuum of care extends beyond a patient’s hospital stay and includes a safe transition to home or a care facility. Improving discharge planning, including the patient’s paperwork, eases this transition. In an effort to improve the discharge process two important concepts were adoptedthe use of checklists and enabling teachback for providers. Checklists have now become commonplace in the surgical arena supported by literature that shows that they improve patient safety. Teachback affords health caregivers an opportunity to gauge health literacy and can serve as a foundation for patient education. We have taken these two cornerstones of patient safety and incorporated them into a new set of discharge instructions that feature patient friendly language, important followup details, medication information and a face sheet that serves as both a checklist and a template for nurses to utilize during teachback when reviewing the instructions with the patient.
The purpose of this study is to assess the effectiveness of a new template for discharge instructions and process redesign on improving inpatient discharge transitions.
We designed a survey to gather information from nurses about discharges from general medicine nursing units. This initial step will test the perceived effectiveness of the newly redesigned discharge instructions. This survey is completed by nurses after they complete the new discharge instructions with patients, allowing nurses to rate the quality of the discharge instructions and also to comment on problems with the instructions themselves. Ultimately, in the second phase of this project, we intend to perform a retrospective chart review on patients that were identified as having problems on the discharge instructions. This review will allow us to rate the impact of preceived problems and identify if there is any correlation with readmission within 30 days of discharge. The goal is to validate that a new discharge instructions template which incorporates a nursing discharge checklist and reinforces teachback modalities can prevent errors on discharge and improve transitions.
To date, we have collected 103 surveys. Problems were identified using the new checklist in 31% of discharges. Of those problems, the most common (44%) were medication related. In 94% of these cases, the problems identified by nursing were corrected prior to actual discharge. Based on initial findings, the combination of a discharge checklist and teachback is a promising innovation to improve overall patient care at discharge. Further studies will shed light on the impact of the new discharge process on outcome measures (HCAHPS, readmission, and followup compliance). Additionally, surgical, pediatric and ICU nursing units will be enrolled in an effort to identify areas of high risk with discharge transitions that may be specialty specific.
To cite this abstract:Hamilton A, Phillips S, Morris W. Med Wreck: Use of Safety Checklists and Teachback As a Novel Approach to Improving Discharge Transitions and Medication Reconciliation Fidelity. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97684. Journal of Hospital Medicine. 2012; 7 (suppl 2). https://www.shmabstracts.com/abstract/med-wreck-use-of-safety-checklists-and-teachback-as-a-novel-approach-to-improving-discharge-transitions-and-medication-reconciliation-fidelity/. Accessed May 23, 2019.