Advancing surgical techniques have supported shorter stays that allow more procedures to be performed in ASCs and HOPDs, reducing the cost of care and increasing convenience for patients. However, that shortened period also decreases the amount of time available for patient education and discharge teaching.
Discharge instructions are so integral to positive patient outcomes and a positive health care experience that accreditation standards include specific requirements for both inpatient and outpatient settings. As one example, ACHC Standard 09.03.02 for ambulatory surgery centers states:
“The organization must provide each patient with written discharge instructions and essential overnight supplies.
The organization must ensure that all patients are informed, either in advance of their procedure or prior to leaving the organization, of their prescriptions, postoperative instructions, need for special supplies beyond the first night, fall prevention, and health care contact information for emergency and follow-up care.”
Historically, discharge education is provided after surgery, but the effects of anesthesia and pain medication can impair a patient’s ability to adequately retain information. Even including written instructions with the packet of discharge documents often is not enough to eliminate reports of uncontrolled pain and higher rates of adverse events when there is poor comprehension of discharge orders. Patients who do adequately understand their discharge plans are at risk of lower post-procedure compliance and increased potential infection with unintended follow-up care being sought in a hospital emergency department. Each factor contributes to decreased satisfaction with their overall experience.
PACU staff already spend valuable time educating their patients. But we need to assess the effectiveness of this teaching and look for ways to improve both understanding of what to expect and what is expected of them when the patient returns home. Clear communication offers a means to prevent an undesired outcome and/or a readmission.
Five simple tips can help ensure that patients fully comprehend and can follow discharge instructions after they leave the ASC or HOPD setting.
- Start education before the surgery. The outpatient procedure that is performed many times each week in your setting is a one-time event for most patients. Learning about the full process, including what to expect during the recovery period, should start as soon as the patient is scheduled for surgery. Patients and their family members can be directed to discharge instructions on a website for review ahead of time. Information there may address, but not be limited to: dressing changes, medication schedules, and general expectations post procedure. Encourage patients and caregivers to write down questions they may have and address these as part of discharge teaching.
- Recognize learning differences. An individualized approach to education can give your patient an advantage when retaining information. If English is not their preferred language, ensure that you have a translator and/or paperwork in the relevant language. Offer information in multiple formats to improve retention. Direct teaching will benefit auditory learners, printed materials incorporating diagrams and graphically organized information will support visual learners, practice (e.g., applying dressings) will be best for kinesthetic learners. There’s no need to evaluate each patient’s learning style; instead, provide information in multiple formats.
- Highlight the most important information. Patients and family members often leave a health care facility burdened with sensory and information overload. They may feel overwhelmed even as they return to the familiarity of home. They may have responsibility for specific wound dressing changes, new medications, dietary changes and other restrictions. Sending patients home with a handout that highlights on focused information related to actions they must take can help.
- Don’t wait for questions. Ask them yourself. Nine times out of ten, if you ask whether your patient or their caregiver has questions, they will say no. The teach-back method is a great way to help ensure the instructions you’ve provided have been understood. Review discharge instructions in sections and ask follow-up questions with each group. For example, after covering pain medication (the last time it was administered and the next time it would be due), you could ask “What time will you need to take your pain medication when you get home?” This technique will help you understand what repetition or additional information is needed.
- Give equal focus on educating family members/caregivers. Since most discharge teaching is done after surgery when the patient may still be under the influence of anesthesia, having a family member or caregiver involved will improve adherence to instructions and accurate patient follow-through. Family and other caregivers can reinforce the information’s importance and ensure the patient gets the care they need. The family will know the patient best and what to emphasize to ensure comprehension and compliance.
Discharge is not the end of care, but a liminal point on the patient’s health care journey. The most effective tool to promote healing at this transition is high-quality education through an intentional approach to discharge instructions.
The importance of communicating clear discharge instructions to patients and their family members cannot be overstated. With these systems in place, we have a great opportunity to improve safety and reduce risk within our organizations.
– Tricia Dixon-Thomas, MSN, RN is a clinical review specialist for the ASC and OBS Accreditation Programs at Accreditation Commission for Healthcare (ACHC) with more than 20 years of experience in ASCs. She is passionate about teaching and mentoring the next generation of outstanding managers and directors in this growing health care environment.
