Communicating discharge instructions to patients: a survey of nurse, intern, and hospitalist practices.

BACKGROUND Comprehensive discharge education can improve patient understanding and may reduce unnecessary rehospitalization. OBJECTIVES To understand nurse and physician communication practices around patient discharge education. SETTING University of California, San Francisco Medical Center (UCSFMC). PARTICIPANTS Nurses, interns, and hospitalists caring for hospitalized medicine patients. MEASUREMENTS Participants were surveyed regarding discharge education practices. The survey asked respondents about 13 elements of discharge education found in the literature. For each element, participants were queried regarding: 1) the provider responsible for this element of patient education; 2) the frequency with which they communicate this teaching to patients; 3) how often they directly communicate with the nurse or physician caring for the patient about each element; and 4) tools to improve nurse-physician communication. RESULTS A total of 129/184 (70%) nurses, interns, and hospitalists responded to the survey. The majority of respondents in all 3 groups felt that 9 of 13 elements were a combined responsibility. Nurses reported educating patients on these 9 items significantly more often than physicians (P < 0.05). All groups also agreed that instruction on 2 of the elements, summary of hospital findings and pending results, should be primarily the physicians' responsibility; these were the elements least often discussed by any provider. Despite the majority of items being agreed upon as a shared responsibility, communication between nurses and physicians regarding discharge education was low. Standardized verbal communication on the day of discharge was supported most strongly by all providers. CONCLUSIONS Ambiguous responsibility for providing discharge education and poor communication between nurses and physicians offers an opportunity for improvement. Journal of Hospital Medicine 2013. © 2012 Society of Hospital Medicine.