October 1st, 2014
The following post is by Dennis Rosen, author of Vital Conversations: Improving Communication Between Doctors and Patients
Hopefully, all of you will live long and healthy lives that will end peacefully in your sleep sometime after seeing your youngest great-grandchild head off to college. Unfortunately, it will be a lot less rosy for most of us. Disease and illness are natural parts of our lives, and as science and technology advance people now live longer—and with more coexisting medical conditions—than ever before. As we get older we tend to consume more medications, and the likelihood of being hospitalized because of an acute health crises increases.
Unfortunately, the high cost of health care has resulted in growing pressure to shorten the length of stays in hospital as much as possible. And while there are many good reasons for doing this—reduced expense, lower likelihood of picking up a secondary infection or experiencing a medical error)—there can be significant downsides as well. Among these are the risks patients face when sent home from the hospital before they are well enough to care for themselves or before they understand how it is, exactly, that they are supposed to do so.
Almost one in five Medicare patients discharged from the hospital will be readmitted within the next thirty days. Interestingly, this also corresponds to the percentage of patients who experience an adverse medical event or complication, two thirds of which involve the medications they are taking. This suggests that better pre-discharge patient education needs to take place. And yet, one study of adult patients being discharged from a large academic hospital in New York found that only 28 percent could name all their discharge meds (on average, fewer than four), and that almost two thirds did not understand why they had been prescribed the medications in the first place.
Although this information is supposed to be included in a printed discharge summary, it is often not as clear as it should be, or even that easy to find among the many pages of small-font verbiage. Let’s not forget as well, that many patients are too anxious, in pain, or simply hazy from the meds they’re on to make sense of the discharge summary as carefully as they should. When you add in the fact that more than one third of Medicare patients possess marginal or insufficient health literacy skills, it’s surprising that the rate of adverse medical events following discharge is as low as it is.