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Discharging better informed patients

Toronto, October 4, 2016

By Evelyne Jhung

Paulina Jaros, RN, and Dean Aide review his PODS
Paulina Jaros, RN, and Dean Aide review his PODS. She ensures he has a good understanding of his care plan after he is discharged by asking him to repeat the instructions in his own words. (Photo by Yuri Markarov)

When Verna Duong, a registered nurse on the Trauma and Neurosurgery unit, used to hand her patients their discharge summary, they often stared at it with a look of confusion.

“The summary was the surgeon’s notes that we’d give to the patient to take back to their family doctor,” said Duong. “The new summaries we have now are much more patient-friendly, with a bigger font size and simpler language.”

Neurosurgery was one of the first two units at St. Michael’s (along with Urology) to pilot the new PODS – patient-oriented discharge summaries. Instead of an overview of what happened during their stay in hospital, PODS summarizes key information that patients need after being discharged: medications; followup appointments; changes to the patient’s routine; symptoms to watch for and how to respond; and where to get more information. It is meant to be a simple care guide that the patient or caregiver can easily follow at home.

“Because the summary is easier to understand, patients and their families seem to be more comfortable asking questions after I go over it with them,” said Paulina Jaros, also a Trauma and Neurosurgery nurse.

sample of the new patient oriented discharge summaries
Bigger font size, clearly organized information, accompanying icons and plain language, paired with teach back from a clinician, make the new patient oriented discharge summaries easier to read and understand. Click here or on the image above to a larger version.

Although other hospitals have piloted PODS, the St. Michael’s approach highlights health literacy best practices, including the use of teach back. That is, staff ask patients to repeat key messages to assess for comprehension.

Jaros asks questions such as, “can you tell me when you have to go see your family doctor?” and “what medications should you take for your pain and when?”

St. Michael’s has also customized the generic PODS document by working with each service to create service-specific templates and building them into the electronic discharge system. This ensures consistency and makes it easier for residents and nurse practitioners to complete.

“When a clinician writes up the discharge summary, the PODS content created for their service is already pre-populated and ready to be tailored to the specific patient being discharged,” said Patrick O'Brien, a quality improvement specialist.

PODS is a vast improvement from the old discharge summaries, however written tools have limited effectiveness in and of themselves.

“The best way to convey this information is to pair the tool with discussion involving the clinician, a patient and their families,” said Katrina Grieve, a patient education specialist. “When we engage patients and families with educational material, they become more comfortable asking questions and more confident in taking the next steps in their care journey.”

   
“Discharge education is a process over the course of the patient journey, not just a moment when they’re about to walk out the door. Being patient-centred means preparing patients and their families for the next steps of their care continuum in a way that meets their needs. This helps to foster better transitions in care.”
- Katrina Grieve, patient education specialist

About St. Michael's Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael's Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.