Many patients don't understand discharge summaries

A week after hospital discharge, even patients who claim to have understood their discharge summaries often have difficulty describing their diagnosis and follow-up plan, a recent study found.

Researchers at Yale-New Haven Hospital enrolled 395 patients age 65 and older who had been hospitalized for acute coronary syndrome, heart failure or pneumonia between May 2009 and April 2010. The patients' medical records were reviewed and they were contacted by phone for an interview within a week after discharge. Results were published by JAMA Internal Medicine on Aug. 19.

Almost all of the patients (95.6%) reported that they understood the reason for their hospitalization, and 90.3% said they had received written instructions prior to discharge, which more than 85% reported were easy to read and understand. But when researchers compared patients' explanations of their hospitalizations to the medical records, they found that only 59.6% fully understood their diagnosis and an additional 32.2% could at least describe their symptoms. Thirty patients (8.2%) showed no understanding. About a quarter of discharge summaries did not describe the patient's diagnosis in lay language, the researchers found.

They also looked at patients' preparation for discharge and found that 30% reported receiving less than a day's advance notice before discharge and that 66.1% had been asked whether they would receive sufficient support at home. According to the records, 32.6% had a follow-up outpatient appointment scheduled before discharge, but only 43.9% of those patients could recall the details of the appointment during the phone interview.

Despite patients' positive reviews of their discharge experiences, discharge practices and patient comprehension are suboptimal, the researchers concluded, noting that asking patients about their understanding does not seem to be a good way to gauge the effectiveness of discharge preparation. “To better assess what was actually done, questions should be constructed to ask about practice rather than perceived understanding,” they wrote. Other potential solutions include patient teach-back or a “universal precautions” approach of treating every patient as if he had cognitive impairment or low health literacy.

Among other limitations, the study was conducted at a single site and did not routinely assess caregivers' understanding, the researchers cautioned. Still, the inclusion of only patients who were discharged to home and could respond to interview questions by telephone may indicate that these results are a best-case scenario, with a more functional patient population than those typically admitted with the studied conditions.