Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Carl J. Shapiro Institute for Education and Research, Boston, Massachusetts.
JAMA Intern Med. 2023 May 1;183(5):417-423. doi: 10.1001/jamainternmed.2023.0070.
Patient education at time of hospital discharge is critical for smooth transitions of care; however, empirical data regarding discharge communication are limited.
To describe whether key communication domains (medication changes, follow-up appointments, disease self-management, red flags, question solicitation, and teach-back) were addressed at the bedside on the day of hospital discharge, by whom, and for how long.
DESIGN, SETTING, AND PARTICIPANTS: This quality improvement study was conducted from September 2018 through October 2019 at inpatient medicine floors in 2 urban, tertiary-care teaching hospitals and purposefully sampled patients designated as "discharge before noon." Data analysis was performed from September 2018 to May 2020.
A trained bedside observer documented all content and duration of staff communication with a single enrolled patient from 7 am until discharge.
Presence of the key communication domains, role of team members, and amount of time spent at the bedside.
Discharge days for 33 patients were observed. Patients had a mean (SD) age of 63 (18) years; 14 (42%) identified as White, 15 (45%) were female, and 6 (18%) had a preferred language of Spanish. Thirty patients were discharged with at least 1 medication change. Of these patients, 8 (27%) received no verbal instruction on the change, while 16 of 30 (53%) were informed but not told the purpose of the changes. About half of the patients (15 of 31, 48%) were not told the reason for follow-up appointments, and 18 of 33 (55%) were not given instructions on posthospital disease self-management. Most patients (27 of 33, 81%) did not receive guidance on red-flag signs. While over half of the patients (19 of 33, 58%) were asked if they had any questions, only 1 patient was asked to teach back his understanding of the discharge plan. Median (IQR) total time spent with patients on the day of discharge by interns, senior residents, attending physicians, and nurses was 4.0 (0.75-6.0), 1.0 (0-2.0), 3.0 (0.5-7.0), and 22.5 (15.5-30.0) minutes, respectively. Most of the time was spent discussing logistics rather than discharge education.
In this quality improvement study, patients infrequently received discharge education in key communication domains, potentially leaving gaps in patient knowledge. Interventions to improve the hospital discharge process should address the content, method of delivery, and transparency among team members regarding patient education.
患者在出院时接受教育对于顺利过渡护理至关重要；然而，有关出院沟通的实证数据有限。
描述关键沟通领域（药物变化、随访预约、疾病自我管理、警示标志、问题征集和回授）是否在医院出院当天由谁在床边进行了讨论，以及讨论了多长时间。
设计、地点和参与者：这项质量改进研究于 2018 年 9 月至 2019 年 10 月在 2 家城市三级教学医院的住院内科病房进行，并对指定为“中午前出院”的患者进行了有针对性的抽样。数据分析于 2018 年 9 月至 2020 年 5 月进行。
一名经过培训的床边观察员从早上 7 点到出院，记录了一名入组患者的所有内容和所有工作人员与患者的沟通时长。
关键沟通领域的存在、团队成员的角色以及在床边花费的时间。
观察了 33 名患者的出院日。患者的平均（SD）年龄为 63（18）岁；14 名（42%）为白人，15 名（45%）为女性，6 名（18%）首选语言为西班牙语。30 名患者出院时至少有 1 种药物发生变化。在这些患者中，8 名（27%）没有接受关于药物变化的口头指导，而 30 名中有 16 名（53%）接受了但没有被告知药物变化的目的。约一半的患者（31 名中的 15 名，48%）没有被告知随访预约的原因，33 名中有 18 名（55%）没有得到关于出院后疾病自我管理的指导。大多数患者（33 名中的 27 名，81%）没有得到关于警示信号的指导。虽然超过一半的患者（33 名中的 19 名，58%）被问到是否有任何问题，但只有 1 名患者被问到是否理解出院计划。住院医生、高级住院医生、主治医生和护士在出院当天与患者在一起的平均（中位数）时间（IQR）分别为 4.0（0.75-6.0）、1.0（0-2.0）、3.0（0.5-7.0）和 22.5（15.5-30.0）分钟。大部分时间都花在了讨论后勤问题上，而不是出院教育。
在这项质量改进研究中，患者在关键沟通领域很少接受出院教育，这可能导致患者知识存在差距。改善医院出院流程的干预措施应针对团队成员的内容、交付方法和患者教育的透明度。
