New discharge form keeps satisfaction high

Helps with instructions, resources at home

For the past two years, the ED at Avera Weskota Medical Center, a small, rural critical-access hospital in Wessington Springs, SD, has been using a new "Emergency Services Aftercare" instruction form to help patients remember vital information about the care they received and instructions to follow once they get home. It might be no coincidence that in 2007, the hospital received The Press Ganey Summit Award, which is based on a department ranking in the 95th percentile or above for at least three years.

In fact, the ED received a ranking of the 99th percentile for the period between Jan. 1, 2007, and June 30, 2007. The new form addresses one of the most pressing issues in emergency medicine today: poor communications upon discharge. In fact, a recent study by the American College of Emergency Physicians found that about 75% of discharged ED patients failed to understand their discharge instructions.

"At the end of a visit the patient is bombarded with all kinds of information, and once they get home they forget it," notes Julie Schultz, LPN, quality improvement coordinator at Weskota. "We developed the form and instructions we want the patient to follow, which they and their spouse can refer to once they get home." The instructions include what patients should and should not do, including when to return to work or school. The form also documents the education that has been given to the patient, the medications they must continue to take, and if they need to have a follow-up visit, she says. "If one of our clinics happens to be open at the time, we will set the appointment up for them," Schultz adds.

The benefit of the form is the fact the patients get information they can refer to that they may have forgotten, says JoAnn Hettinger, RN, director of patient care services. "You can give them verbal instructions, but the visual form is a lot better," Hettinger says.

Previously, patients simply received oral instructions or staff might have written the instructions on a piece of paper, but it was not consistent, says Schultz. Now, the patients and nurses sign the form to indicate it has been reviewed. "Many times the provider will personally review it with the patient [rather than the discharge nurse], adds Schultz.