Patient experience with discharge instructions in postdischarge recovery: a qualitative study

• Published in: BMJ open Vol. 7; no. 2; p. e014842
• Main Authors: Horstman, Molly J, Mills, Whitney L, Herman, Levi I, Cai, Cecilia, Shelton, George, Qdaisat, Tareq, Berger, David H, Naik, Aanand D
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01-02-2017; BMJ Publishing Group
• Subjects: Adult; Aged; Aged, 80 and over; Caregivers; Cognitive ability; Colorectal surgery; Colorectal Surgery - psychology; Colorectal Surgery - rehabilitation; Communication; Data collection; Elective Surgical Procedures; Empowerment; Female; Formative evaluation; Health care; Health Personnel - education; Health Services Research; Hospitals; Humans; Informed consent; Interviews; Interviews as Topic; Male; Middle Aged; Patient Discharge; Patient Safety; Patient-centered care; Patients; Physicians; Primary care; Qualitative Research; Quality Assurance, Health Care - standards; Recovery (Medical); Tertiary Care Centers; Texas; Veterans; Care Transitions; Discharge Instructions
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2016-014842

ObjectivesWe examined the role of discharge instructions in postoperative recovery for patients undergoing colorectal surgery and report themes related to patient perceptions of discharge instructions and postdischarge experience.DesignSemistructured interviews were conducted as part of a formative evaluation of a Project Re-Engineered Discharge intervention adapted for surgical patients.SettingMichael E. DeBakey VA Medical Center, a tertiary referral centre in Houston, Texas.ParticipantsTwelve patients undergoing elective colorectal surgery. Interviews were conducted at the two-week postoperative appointment.ResultsParticipants demonstrated understanding of the content in the discharge instructions. During the interviews, participants reported several positive roles for discharge instructions in their postdischarge care: a sense of security, a reminder of inhospital education, a living document and a source of empowerment. Despite these positive associations, participants reported that the instructions provided insufficient information to promote access to care that effectively addressed acute issues following discharge. Participants noted difficulty reaching providers after discharge, which resulted in the adoption of workarounds to overcome system barriers.ConclusionsDespite concerted efforts to provide patient-centred instructions, the discharge instructions did not provide enough context to effectively guide postdischarge interactions with the healthcare system. Insufficient information on how to access and communicate with the most appropriate personnel in the healthcare system is an important barrier to patients receiving high-quality postdischarge care. Tools and strategies from team training programmes, such as team strategies and tools to enhance performance and patient safety, could be adapted to include patients and provide them with structured methods for communicating with healthcare providers post discharge.