Lowering Hospital Readmissions for At-Risk Patients

A version of this article originally appeared at NucleusHealth.com.

Mr. Thompson, a 67-year-old pneumonia patient, is being discharged from the hospital after a three-day stay. He’s overwhelmed from being in the hospital, and isn’t paying full attention to the nurse giving him instructions. Mrs. Alvarez, a Spanish-speaking heart patient, is also being discharged. She doesn’t understand the instructions for her new prescription medication, but is embarrassed to ask for clarification. Within days, both will be back in the ER; Mr. Thompson with a diagnosis of recurrent pneumonia, and  Mrs. Alvarez due to complications from her meds.

Unfortunately, these scenarios are a daily reality in our healthcare system. The issue of readmission typically stems from patients’ low health literacy. Health literacy is the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. (We’ve discussed the widespread problem of low health literacy in previous posts on the Nucleus blog.) In order to help patients like Mr. Thompson and Mrs. Alvarez, hospitals have had to examine their practices and implement new strategies for improving their discharge processes and keeping patients out of the hospital.

Gwinnett Medical Center near Atlanta, Georgia, has done just that. Lynne Sycamore, Gwinnett’s Patient and Family Education Coordinator, worked with Nucleus Medical Media to develop a simple, effective approach for educating patients at the point of care and again at home.

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Gwinnett Medical Center uses a four-step process: “First, our staff shows patients the discharge animations in the hospital, and follows it up with a teach-back session,” explains Sycamore. “We discover what questions they have, and ask patients to explain the content in their own words. Afterward, patients receive an illustrated handout with a link to the website so they can review the material at home.” That website is Caring for Yourself After Surgery, and it features educational discharge animations about caring for surgical drains, removing Foley catheters, checking blood flow to areas after surgery, and using crutches.

How do patients with low health literacy, like our theoretical Mr. Thompson and Mrs. Alvarez, benefit from this new process and website? Gwinnett’s website was built specifically for populations most vulnerable to low health literacy, including ethnic groups that speak English as a second language, the poor, the under-educated, and the elderly.1  For example, in order to serve a diverse local population and overcome language barriers, Gwinnett’s animations are available in English, Spanish, and Korean. The scripts for the animations are written at a 5th-8th grade level, making the information easier for everyone to understand. Lastly, the website incorporates responsive design, allowing it to function on computers, tablets, and smartphones.

Sycamore believes this process, and especially the narrated animations, will help patients when they get back home. “When patients leave our care, they’re still feeling the effects of anesthesia, or they may be on pain medication. Patients may not remember everything we’ve told them. If they prefer the paper form, they can follow those instructions, and if they need more direction, they can go back to the website and watch the animations again,” she says.


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Sources:

1 Kutner M, Greenberg E, Jin Y, Paulsen C. (2006). The health literacy of America’s adults: results from the 2003 National Assessment of Adult Literacy. U.S. Department of Education, Institute of Education Sciences, and National Center for Education Statistics.


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