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Health services research
Research
Patient experience with discharge instructions in postdischarge recovery: a qualitative study
  1. Molly J Horstman1,2,3,
  2. Whitney L Mills1,2,
  3. Levi I Herman1,4,
  4. Cecilia Cai5,
  5. George Shelton1,6,
  6. Tareq Qdaisat7,
  7. David H Berger1,8,
  8. Aanand D Naik1,2,3
  1. 1Center for Innovations in Quality, Effectiveness, and Safety (IQuESt); Michael E. DeBakey VA Medical Center, Houston, Texas, USA
  2. 2Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
  3. 3VA Quality Scholars Coordinating Center, IQuESt, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
  4. 4Jesse H. Jones Graduate School of Business, Rice University, Houston, Texas, USA
  5. 5Internal Medicine Residency Program, Baylor College of Medicine, Houston, Texas, USA
  6. 6Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas, USA
  7. 7Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas, USA
  8. 8Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
  1. Correspondence to Dr Molly J Horstman; molly.horstman{at}bcm.edu

Abstract

Objectives We 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.

Design Semistructured interviews were conducted as part of a formative evaluation of a Project Re-Engineered Discharge intervention adapted for surgical patients.

Setting Michael E. DeBakey VA Medical Center, a tertiary referral centre in Houston, Texas.

Participants Twelve patients undergoing elective colorectal surgery. Interviews were conducted at the two-week postoperative appointment.

Results Participants 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.

Conclusions Despite 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.

  • Discharge Instructions
  • Care Transitions

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjopen-2016-014842

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    Footnotes

    • Contributors WLM, DHB and ADN made substantial contributions to the conception or design of the work; MJH, WLM, LIH, CC, GS, TQ and ADN made substantial contributions to the acquisition, analysis or interpretation of the data; MJH, WLM and ADN drafted the manuscript; LIH, CC, GS, TQ and DHB revised the manuscript critically for important intellectual content; all authors gave the final approval of the version to be published.

    • Funding This research was supported by Health Services Research and Development Quality Enhancement Research Initiative (RRP 12-532) grant awarded to Dr Naik, and in part with resources at the Veterans Affairs HSR&D Center for Innovations in Quality, Effectiveness and Safety (CIN 13-413) at the Michael E. DeBakey VA Medical Center, Houston, TX. Dr Horstman is supported by the VA Office of Academic Affiliations Advanced Fellowship in Health Services Research at IQuESt.

    • Disclaimer Engineered Care was not involved in the design of this study, analysis of the interviews or writing of the manuscript. Engineered Care did not provide any financial support for this study.

    • Competing interests none declared.

    • Ethics approval This study (IRB: H-29099) was reviewed and approved by the Institutional Review Board at Baylor College of Medicine and the VA Research and Development Committee at the Michael E. DeBakey VA Medical Centre.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Participants did not provide consent for the transcripts to be released outside of the Michael E. DeBakey VA Medical Center.