Evaluation of discharge instructions among hospitalized Lebanese patients
Main Article Content
Patient Discharge, Counseling, Quality of Health Care, Patient Readmission, Professional Practice, Hospitals, University, Emergency Service, Hospital, Surveys and Questionnaires, Lebanon
Background: Hospital readmissions are considered as the primary indicator of insufficient quality of care and are responsible of increasing annual medical costs by billions of dollars. Different factors tend to reduce readmissions, particularly instructions at discharge.
Objectives: Our study objective was to evaluate discharge instructions given to hospitalized Lebanese patients and associated factors.
Methods: Two hundred patients, aged between 21 and 79 years and admitted to the emergency department, were recruited from a Lebanese university hospital. Discharge instructions were evaluated by a face-to-face interview to fill a questionnaire with the patients immediately after their final contact with the physician or nurse in charge. We mainly focused on medications instructions and created two scores related to “instructions given” and “instructions appropriate” to later conduct bivariate analysis.
Results: We found that discharge instructions were not completely given to all our study population. The degree of appropriateness fluctuated between 25% and 100%. The instructor in charge of giving discharge instructions had its significant influence on medication instructions given (p=0.014). In addition, the instructor and his experience influenced the degree of “appropriate instructions”. In fact, our study showed that despite being capable of giving good medication advice, nurses’ instructions were significantly less effective in comparison with physicians, fellows and residents. However, nurses gave 52% of the instructions, which questions the quality of those instructions.
Conclusions: In conclusion, our observational study showed that in a Lebanese university hospital, patients’ understanding of discharge instructions is poor. Careful attention should be drawn to other hospitals as well and interventions should be considered to improve instructions quality and limit later complications and readmissions. The intervention of clinical pharmacists and their medication-related advice might be crucial in order to improve instructions’ quality.
2. Lu N, Huang KC, Johnson JA. Reducing excess readmissions: promising effect of hospital readmissions reduction program in US hospitals. Int J Qual Health Care. 2016;28(1):53-58. https://doi.org/10.1093/intqhc/mzv090
3. Marks C, Loehrer S, McCarthy D. Hospital readmissions: measuring for improvement, accountability, and patients. Issue Brief (Commonw Fund). 2013;24:1-8.
4. Taylor DM, Cameron PA. Discharge instructions for emergency department patients: what should we provide? J Accid Emerg Med. 2000;17(2):86-90. https://doi.org/10.1136/emj.17.2.86
5. Wong EL, Yam CH, Cheung AW, Leung MC, Chan FW, Wong FY, Yeoh EK. Barriers to effective discharge planning: a qualitative study investigating the perspectives of frontline healthcare professionals. BMC Health Serv Res. 2011;11(1):242. https://doi.org/10.1186/1472-6963-11-242
6. Taylor DM, Cameron PA. Emergency department discharge instructions: a wide variation in practice across Australasia. J Accid Emerg Med. 2000;17(3):192-195. https://doi.org/10.1136/emj.17.3.192
7. Sheikh H, Brezar A, Dzwonek A, Yau L, Calder LA. Patient understanding of discharge instructions in the emergency department: do different patients need different approaches? Int J Emerg Med. 2018;11(1):5. https://doi.org/10.1186/s12245-018-0164-0
8. Norouzinia R, Aghabarari M, Shiri M, Karimi M, Samami E. Communication Barriers Perceived by Nurses and Patients. Glob J Health Sci. 2015;8(6):65-74. https://doi.org/10.5539/gjhs.v8n6p65
9. Hoek A, Anker SCP, van Beeck EF, Burdorf A, Rood PPM, Haagsma JA. Patient discharge instructions in the Emergency Department and their effects on comprehension and recall of discharge instructions: a systematic review and meta-analysis. Ann Emerg Med. 2019 [Epub ahead of print]. https://doi.org/10.1016/j.annemergmed.2019.06.008
10. Impact of Communication in Healthcare - Institute for Healthcare Communication; 2011. Available at: http://healthcarecomm.org/about-us/impact-of-communication-in-healthcare (accessed Apr 27, 2018).
11. Murray MD., Kroenke K. Polypharmacy and medication adherence: small steps on a long road. J Gen Intern Med. 2001;16(2):137-139.
12. El-Jardali F, Alameddine M, Jamal D, Dimassi H, Dumit NY, McEwen MK, Jaafar M, Murray SF. A national study on nurses’ retention in healthcare facilities in underserved areas in Lebanon. Hum Resour Health. 2013;11:49. https://doi.org/10.1186/1478-4491-11-49
13. Ravaghi H, Afshari M, Isfahani P, Belorgeot V. A systematic review on hospital inefficiency in the Eastern Mediterranean Region: sources and solutions. BMC Health Serv Res. 2019;19(1):830. https://doi.org/10.1186/s12913-019-4701-1
14. Abou Mrad F, Tarabey L. Cultural diversity and quality care in Lebanon. Journal of Clinical Research & Bioethics; 2012. Online, cited on. Available at: https://www.omicsonline.org/cultural-diversity-and-quality-care-in-lebanon-2155-9627.1000140.pdf (accessed Jun 29, 2018).
15. Engel KG, Buckley BA, Forth VE, McCarthy DM, Ellison EP, Schmidt MJ, Adams JG. Patient understanding of emergency department discharge instructions: where are knowledge deficits greatest? Acad Emerg Med. 2012;19(9):E1035-E1044. https://doi.org/10.1111/j.1553-2712.2012.01425.x
16. Marty H, Bogenstätter Y, Franc G, Tschan F, Zimmermann H. How well informed are patients when leaving the emergency department? comparing information provided and information retained. Emerg Med J. 2013;30(1):53-57. https://doi.org/10.1136/emermed-2011-200451
17. Schienkiewitz A, Mensink G, Scheidt-Nave C. Comorbidity of overweight and obesity in a nationally representative sample of German adults aged 18-79 years. BMC Public Health. 2012;12:658. https://doi.org/10.1186/1471-2458-12-658
18. Sacre H, Hallit S, Hajj A, Zeenny RM., Sili G, Salameh P. The pharmacy profession in a developing country: Challenges and suggested governance solutions in Lebanon. J Res Pharm Pract. 2019;8(2):39-44. https://doi.org/10.4103/jrpp.JRPP_19_5
19. Zaal RJ, Jansen MM, Duisenberg-van Essenberg M, Tijssen CC, Roukema JA, van den Bemt PM. Identification of drug-related problems by a clinical pharmacist in addition to computerized alerts. Int J Clin Pharm. 2013;35(5):753-762. https://doi.org/10.1007/s11096-013-9798-4
20. Reis WC, Scopel CT, Correr CJ, Andrzejevski VM. Analysis of clinical pharmacist interventions in a tertiary teaching hospital in Brazil. Einstein (Sao Paulo). 2013;11(2):190-196. https://doi.org/10.1590/s1679-45082013000200010
21. Gallagher J, Byrne S, Woods N, Lynch D, McCarthy S. Cost-outcome description of clinical pharmacist interventions in a university teaching hospital. BMC Health Serv Res. 2014 Apr 17;14:177. https://doi.org/10.1186/1472-6963-14-177