Implementing Multimedia Discharge Instructions for Cardiac Patients 65 Years and Older to Improve Outcomes

Discharge instructions are an integral part of the care continuum and support a successful transition from care facility to home. Patient safety becomes a major concern when discharge instruction is confusing or misunderstood. Modern discharge instructions are often difficult to understand, resulting in ineffective communication for patients with visual, hearing, cognitive and sensory limitations, as is the preponderance among older adults. Discharge instructions using a variety of multimedia and educational techniques may provide a means to satisfy the learning disparities, language barriers, and visual and auditory deficits of many older adults. This project aims to identify specific barriers older adults encounter in their attempt to understand current discharge instruction, and to develop a discharge instruction approach that would better address patients' questions and concerns prior to, and after, a cardiac procedure. The objectives of this project were to 1) evaluation of contemporary written discharge instructions for barriers to understanding; 2) identify barriers patient's experience with present discharge processes, designs for improved interventions, and methods for implementation and dissemination; 3) develop a prototype multimedia discharge instruction platform using a variety of educational modalities, with a focus on feasibility in the acute care setting for broader implementation; and 4) disseminate project findings to stakeholders via a poster presentation, a prototype of a re-designed discharge instruction platform, and a white-paper submitted to a professional meeting. Executing the project involved development of a questionnaire administered to both patients and health care providers to identify barriers patients encounter with modern discharge instruction, and to solicit ideas for improvement and application of a re-designed discharge tool. Evaluation of questionnaire responses highlighted perceived barriers, needed interventions, requirements for implementation, and methods for dissemination of effective discharge instructions. A multimedia discharge platform was developed based on participant response, using a variety of educational techniques and learning methods, including graphics, illustrations, video, audio, and text. At project completion, a poster presentation, prototype of the re-designed discharge platform, and a white paper was presented to local stakeholders. Older adults represent the largest patient population readmitted after an acute hospitalization, costing Medicare over $17 billion annually. Discharge instructions provide key information for a successful transition from the acute care setting. A re-design of current discharge instructions may satisfy many of the reading, literacy, and language disparities experienced by older adults, potentially decreasing hospital readmissions and morbidity, while improving patient outcomes.