02:28am Sunday 08 December 2019

Discharge letter for patients increases understanding of hospitalisation

Published in the Internal Medical Journal, the study found that while patients knew why they went into hospital, they had very little understanding of the tests performed while there, and recommendations for what to do when they go home.

“Patients can often be anxious, and this may interfere with their understanding and recall of what has happened in hospital and what the required follow-up is,” said senior investigator of the study Professor Geoffrey Tofler, Preventative Cardiology at University of Sydney, and Cardiologist at Royal North Shore Hospital.

“Discharge summaries are typically written for the doctors not the patient, so often use complex medical terminology that the patient doesn’t understand. The end result is that recommendations are often discarded,” Professor Tofler said.

“This lack of understanding when patients make the transition from the hospital to the community can lead to health problems including an increased need for re-hospitalisation.”

In the study, patients were given a brief one-page letter that was written in simple language that summarised their hospitalization – the letter was then discussed with the patient.

The PADDLE letter was divided into four sections:

– The reasons for hospitalisation (symptoms and diagnosis)

– Tests and results whilst in hospital

– Treatments received in hospital

– Recommendations once discharged from hospital

“Our results found that the letter was well received by the patients, with 93 per cent rating it very helpful or helpful,” said Professor Tofler.

“Patients leaving hospital after receiving the discharge letter are much better informed about their medical condition and their role in the critical early period post-discharge.”

Tony Spencer, a patient recipient of the PADDLE letter said that “I found Dr Tofler’s patient letter extremely helpful when I left hospital after being treated for a heart condition.

“Being succinct and personally written it served as a quick checkpoint to assure me that I am following the right course of action.

“The letter covered my follow up appointments, medications, and reinforced the need for lifestyle changes such as quitting smoking. It also explained the heart scan I had while in hospital as I had been unable to get information on the outcome prior to that.

“Without doubt, the patient letter will result in more people following their prescribed recommendations,” Mr Spencer said.

“The patient discharge letter only takes 5-10 minutes to write (completed by the patients’ doctors) with the contents explained to the patient at their bedside,” said Professor Tofler.

“This is a small change to practice that could make a large difference in patient’s lives, and could prevent subsequent hospital readmissions and their associated costs.

“Interventions that improve understanding for the patient and their families are becoming increasingly important, and together with more rigorous discharge planning and post-discharge patient education, we can improve outcomes.

“The PADDLE letter deserves further evaluation and consideration for integrating into routine discharge practice,” he said.

Study authors were: Raymond Lin, Robyn Gallagher, Monica Spinaze, Hadi Nojoumian, Christopher Dennis, Roderick Clifton-Bligh, and Geoffrey Tofler.

Media enquiries: Kobi Print 0481 012 729, 9036 7589, kobi.print@sydney.edu.au

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