Reducing Avoidable Readmissions Due to Patient Misunderstanding of Post-Discharge Treatment Plans
Oregon Health and Science University cut readmissions for heart failure patients by 11 percent over an 18-month period.
Oregon Health and Science University
3181 S.W. Sam Jackson Park Road
Portland, OR 97239
Oregon Health and Science University is a 560-bed teaching hospital in Portland, Oregon that treats more than 200,000 patients annually.
Jayne Mitchell, ANP
P: (503) 494-8311
Like most hospitals, patients discharged with heart failure return to Oregon Health and Science’s emergency room within seven days. To address this issue, the hospital tasked specific staff with developing interventions to reduce the hospital high readmission rate. To commence, staff sought to determine some of the factors causing the high readmissions rate by conducting “a root cause analysis.” For several weeks, staff shadowed nurse practitioners as they discharged patients and talked with some of the patients about their experiences. They discovered that patients didn’t understand their discharge instructions and were confused and overwhelmed by the process.
To tackle these issues, staff first worked to incorporate better heart failure education materials into the patient care process. Staff sought—and received—approval to use the widely respected University of North Carolina’s Heart Failure Self-Management materials. Next, working with a health literacy expert already employed by the hospital, staff were able to simplify and minimize the discharge order set—bringing the reading level from a 12th grade level to a 6th grade level. To ensure patients understood their condition and treatment plans, nurses engaged in daily heart failure education sessions with patients upon admission to the hospital. To reinforce understanding, nurses employed the “teach back” method with patients during the sessions. Instead of asking patients, “Do you understand your treatment plan?” they asked patients to explain specific parts of their treatment plan in their own words.
By incorporating new heart failure education materials, simplifying the discharge instructions and employing the teach back technique, Oregon Health and Science reduced readmissions for heart failure patients by 11 percent over an 18-month period.