Did you know? Studies show that adverse events, many of which can be serious, are a high risk for patients after a care transition from inpatient hospital care to home—and, many of these events are preventable through good communication and education before discharge. Patients who have a clear understanding of their after-hospital care instructions, including how to take medicines and when to make follow-up appointments are 30% less likely to be readmitted or visit the emergency department than patients who lack this information (Educating patients before discharge reduces readmissions, emergency department visits, and saves money, 2009). However, many patients leave the hospital without the critical knowledge they need. In an interview study of patient perceptions and understanding of discharge instructions among patients 65 years and older who felt they had a good understanding of their discharge instructions, 40% were unable to accurately describe the reason for their hospitalization and 54% did not accurately recall instructions about their follow-up appointment (Horwitz, et al., 2013).
Patient and caregiver education about care after discharge should cover essential elements such as: medications to take and how to administer them, side effects to watch for, how to perform self-care, proper diet, how to monitor important health conditions, and follow-up appointments, and it must also be clearly understood.
Use These 7 Essential Strategies to Maximize Your Communication Effectiveness
1. Include key learners
One of the top reasons patient education fails is because key learners are not included in the learning process. To identify key learners, ask patients questions like:
- “Who will help you with care at home?”
- “Who will go with you to follow-up appointments?”
- “Who should be included in instructions about care after discharge?”
2. Include written materials that are language and literacy appropriate
Instructions should be: brief, focused on critical information, primarily directed at what the patient needs to understand to manage his or her condition, and in the patient’s preferred language. The American Medical Association recommends written information be targeted to a sixth-grade audience because nearly half of the U.S. population is only marginally literate, with an elementary or middle-school reading level (Weiss, 2003). Include simple pictures, graphs, charts, and diagrams when possible.
3. Use plain language
According to the Institute of Medicine, even very well educated individuals may not fully understand medical information, especially when these individuals are made more vulnerable by poor health. The use of plain language applies to verbal and written communication, and includes avoiding medical jargon and using everyday examples to explain technical terms. Some common examples include:Instead of “fatigue,” use “feeling tired and weak”
- Instead of “edema,” use “swelling”
- Instead of “contraindication,” use “dangerous to give” or “wrong”
- Instead of “anterior” and “posterior,” use “front” and “back”
- Instead of “hypertension,” use “high blood pressure”
- Instead of “embolism,” use “blood clot”
- Instead of “persistent,” use “there all the time” or “doesn’t go away”
- Instead of proximal,” use “near to” or “closer to the center of the body”
- Instead of “analgesic,” use “pain reliever”
- Instead of “perspire,” use “sweat”
4. Use teach-back
Using the teach-back method for confirming learner understanding of information being explained improves compliance with treatment plans and leads to better outcomes. If understood, the learner should be able to “teach-back” the information accurately. An example of a teach-back questions is: “I want to make sure I explained things clearly, can you tell me some of the side effects to watch for with your medicine?”
5. Use interpreters
According to the Agency for Healthcare Research and Quality, nearly 9% of the U.S. population is at risk for adverse events because of barriers associated with their language ability. In addition, the Department of Justice and the Department of Health and Human Services have stated that failure to provide appropriate interpreter services can be considered discrimination based on national origin. Use of qualified in-person medical interpreters (or access to telephone or video) for patients with limited English proficiency is recommended for high-risk scenarios, which include: medication reconciliation, patient discharge, informed consent, emergency department care, and surgical care. (Betancourt, Renfrew, Green, Lopez, & Wasserman, 2012)
6. Take a multidisciplinary approach
Nurses often play a primary role in educating patients for care transitions after hospital admission, but the expertise of other practitioners, such as pharmacists, dietitians, and physical therapists is especially beneficial when patients have complex medication, dietary, and therapy regimens. In 2012, a study published in the American Journal of Medical Quality showed that pharmacist-provided discharge counseling resulted in medication interventions, improved patient satisfaction, and increased medication adherence. (Sarangarm, et al., 2013)
7. Encourage questions and note-taking
Patients are sometimes embarrassed to ask questions, and in some cultures, deference to authority stifles questions. Encouraging questions is an important way to engage patients as active partners in their care. In addition, note-taking enables recall and the synthesis of new information (DeZure, Kaplan, & Deerman). For especially important instructions or critical areas of emphasis, ask the patient to underline or place a star beside them.
Now Trending: Overcoming Communication Barriers
It can be difficult to for patients to comprehend complex post-discharge instructions even when conditions are ideal for teaching and learning, but add a number of common communication barriers and it’s no wonder much of it is often misunderstood or can’t be remembered. Studies show that 40–80% of medical information patients are told during office visits is forgotten immediately, and nearly half of the information retained is incorrect (Kessels, 2003).
Prevent Communication Breakdowns Caused by Common Barriers by Following These Ten Important Do’s and Don’ts.
1. Be prepared
Good communication starts with identifying potential barriers unique to each patient. You should know the patient’s preferred language, how he or she prefers to receive information, any sensory issues, and assistive devices the patient needs. Use the information to make sure the right written materials are printed, arrangements are made for language services when needed, and the appropriate resources and other aids are available.
2. Eliminate distractions
Closing the door and asking the patient to turn off the TV helps reduce disturbances. It also conveys the message that the information you’re about to share is important and they should pay attention.
3. Maximize vision and hearing capabilities
Encourage the use of corrective lenses or hearing aids if they’re used at home. Adjust lighting and be aware of background noise. Ask the patient where you should sit to best be seen and heard. Make sure your face is visible when you’re speaking.
4. Be aware of your non-verbal communication
Your body language, tone of voice, and facial expressions should convey friendliness, patience, and attentiveness. Watch for non-verbal cues in the patient that might signal concerns or disagreements, a lack of understanding, or a loss of attention.
5. Know when it’s time to change your strategy
Repeating the same thing, in the same way, again and again, isn’t likely to result in a better outcome when a patient is having a hard time grasping a concept. Change it up with the use of stories, examples, demonstrations, drawings, diagrams, models, videos and other tools that may be more effective.
6. Don’t explain too many concepts at one time
A person’s attention span is like a fuel tank. When it’s full, the ability to process and retain information is maximized. In other words, information is more likely to be grasped correctly and remembered for a longer period of time. As the tank becomes less full so does the ability to comprehend and retain, so concepts aren’t as clear and can’t be remembered as long. Once the tank is empty, communicating more information is useless—it won’t go anywhere. That’s why you should discuss the most critical information first and stop before the tank is empty. You can then wait to introduce new concepts after the patient has had time to refuel.
7. Don’t use family members as interpreters
This is important for two main reasons: 1) Bilingual family members may lack a good vocabulary of medical terminology, and 2) They aren’t impartial and may add their own opinions or only relay information they want the patient to hear. When discussing important information, always use trained medical interpreters.
8. Don’t ask, “Do you understand?”
Many people who do not understand may still answer “Yes.” Use teach-back questions instead such as “I want to make sure I did a good job explaining, so would you tell me what side effects of your medication you should watch out for?”
9. Don’t blame the patient when he doesn’t understand
It’s your job to communicate in a manner the patient can understand and teach-back is a tool for testing your performance. When a misunderstanding is revealed, don’t shame the patient, take ownership. You might say, “I need to do a better job of explaining” or “Maybe I should explain it in a different way.”
10. Don’t interrupt
Listening is an essential part of good communication, and patients need to feel they’re fully heard and understood. Resist the urge to interrupt. After communicating important information, ask them to take a minute or two to look over things you’ve discussed and think about questions they have. Sitting quietly through a few seconds of silence can feel awkward for some people. Practicing this technique will help you become more comfortable.
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Betancourt, J., Renfrew, M., Green, A., Lopez, L., & Wasserman, M. (2012). Improving Patient Safety Systems for Patients with Limited English Proficiency: A Guide for Hospitals. The Disparities Solutions Center. Rockville, MD: Agency for Healthcare Research and Quality. Retrieved from https://www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/ lepguide/lepguide.pdf
DeZure, D., Kaplan, M., & Deerman, M. (n.d.). Research on Student Notetaking: Implications For Faculty and Graduate Student Instructors.
Educating patients before discharge reduces readmissions, emergency department visits, and saves money. (2009, March). Retrieved from Agency for Healthcare Research and Quality: https://archive.ahrq.gov/news/ newsletters/research-activities/mar09/0309RA1.html
Healthcare Utilization Project. (n.d.). HCUP Statistics on Hospital-Based Care in the United States, 2006. Retrieved from Healthcare Utilization Project: https://www.hcup-us.ahrq.gov/reports/factsandfigures/2007/exhibit1_4.jsp
Horwitz, L., Moriarty, J., Chen, C., Fogerty, R., Brewster, U., Kanade, S.,… Krumholz, H. (2013). Quality of discharge practices and patient understanding at an academic medical center. JAMA Internal Med, 1715. Kessels, R. (2003). Patients’ memory of medical information. J R Soc Med, 219–22.
Presbycusis. (1997). NIDCD. Retrieved from http://www.nidcd.nih.gov/health/ hearing/presbycusis.htm
Sarangarm, P., London, M., Snowden, S., Dilworth, T., Koselke, L., Sanchez, C.,… Ray, G. (2013, July/August). Impact of Pharmacist Discharge Medication Therapy Counseling and Disease State Education. American Journal of Medical Quality, 28(4), 292–300.
Use the Teach-Back Method: Tool #5. (2015, February). Retrieved from AHRQ: https://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/ tools/literacy-toolkit/healthlittoolkit2-tool5.html
Weiss, B. (2003). Health Literacy: A Manual for Clinicians. American Medical Association, American Medical Foundation.
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