Going Home at Last: Hospital Instructions

“You’re going home today” may be the sweetest words when you’re in the hospital.

Whether you are taking a new baby home with you, or going home with a walker at the age of 85, getting out of the hospital represents a milestone in your life.

How reliably do hospitals give instructions to patients about what to do during their recovery at home?  For many years now, the federal government reports each hospital’s scores at the Hospital Compare website at medicare.gov.  The scores are very high nationally, according to the most recent survey results posted online. On average, 87% of patients reported YES, they were given information about what to do when they got home from the hospital.  The better hospitals have 90% or more of their patients saying YES, they got the info.  This question on the survey gets the highest score of any of the questions reported online.

The scores were much lower, however, when patients were asked about how well they UNDERSTOOD those instructions.  In fact, the percent of patients nationwide who strongly agree they understood their care when they left the hospital, was just over half (52%).  This question, newly added to the public report, scored the lowest of any questions reported online.

Why the gap?  The answer requires looking at it from three perspectives*: hospital staff, patients and caregivers. Each group has responsibilities that can improve performance.

Hospital staff must have adequate staffing and not rush through the education.  Their teaching materials must be simple enough to get the important points across, and not be too complicated.  Sometimes staff miss opportunities to connect with the patients.  They might misunderstand family member or caregiver questions and concerns.

Patients might not understand instructions because the information itself is very complicated. After all, today’s medical care is highly sophisticated.  Patient concentration might be affected by being tired, or by side effects of their medications.  Patients might not be ready to learn, because all they can think of is getting home, getting back to their bed, their food, their family and friends. This sense of urgency can interfere with thinking through practical aspects.  How will you integrate the requirements for recovery into your normal daily routine?

Patients must be patient with rebuilding their strength after a hospital stay.  Bed rest may have been necessary in the hospital, but it’s not good for working your muscles or your mental status. Lying in bed can also bring on incontinence. (How frightening is that?)  Read up on a concept called “deconditioning” resulting from just being in the hospital for a few days, and you may learn some horrifying outcomes.  If you’re of an advanced age, your overall physical shape likely will not be at the same level immediately, as it was before you got sick and entered the hospital.  Your expectations about assistance and the ability to be completely independent after a hospital stay may need to be modified to be realistic.  The hospital staff should be explaining this and answering your questions.

This is where the caregiver perspective comes in.  Your caregiver family or friend who is going to help you recover needs to be part of the discharge conference.  That person is your second set of eyes and ears to understand what the post-hospital instructions actually are.  S/he might think of additional questions and be more willing to challenge the hospital staff to explain things in understandable layman’s terms.  Caregivers might have practical questions about setting up medications, dressing wounds, modifying meals, knowing what signs and symptoms to watch for, and setting up your next follow-up appointment.  Most states have recently passed a law, the CARE (Caregiver Advise, Record, Enable) Act, to make sure caregivers are respectfully brought into the hospital’s education needed for the patient’s care at home.

When Hospital Compare assesses how well patients UNDERSTOOD their care and creates an aggregate score, they explored three areas:

During this hospital stay…

• Did hospital staff consider your health care options and wishes when deciding what kind of care you would need after leaving the hospital?
• Did you and/or your caregivers understand what you would have to do to take care of yourself after leaving the hospital?
• Did you know what medications you would be taking and why you would be taking them after leaving the hospital?

The answers get rolled up into one score for question 9 – the percent of patients who strongly agreed they “understood the type of care they would need after leaving the hospital”.  When comparing hospitals, the score on question 9 is a vitally important score to examine.  Many small hospitals and surgical specialty hospitals are already scoring over 60%.  If you are on the board of directors for a hospital, this would be a good topic to discuss at your next board meeting.  Because it is one of the newer areas added to the publicly reported scores, it might not have received as much attention as it deserves. Is your hospital performing at a level that exceeds the national average of 52%, and are you comfortable with your score?

For more information and to check your Hospital’s HCAHPS Patient Experience Scores, see Hospital Ratings from Patients & Consumers – Satisfaction Scores – free at ConsumerHealthRatings.com .

*Helpful reference: “Patient Experiences of Transitioning from Hospital to Home” by Cain, Neuwirth et al, Journal of Hospital Medicine, May/June 2012.