EvaRee Fesi

Faculty Advisor: Sandra Scheidenhelm, RN, D.N.P., NEA-BC

Introduction

Patients often struggle to comprehend discharge instructions, especially after receiving anesthesia, which impairs memory retention (Alzahrani et al., 2021; Cook et al., 2022; Hahn-Goldberg et al., 2021). A review of discharge procedures and Press Ganey® data from October to December 2024 at a central Illinois hospital, on an Ambulatory Care Unit, revealed gaps in patient understanding, particularly regarding anesthesia-related information. The timing of when patients receive discharge instructions and how they are delivered may play a vital role in patients understanding their instructions once they are home. This quality improvement project aimed to ensure patients understood their discharge instructions with a focus on three main questions "anesthesia information easy to understand, anesthesia side effects easy to understand, and understand instructions regarding recovery."

Methods

This quality improvement project assessed adult patients aged 18–99 discharged from the Ambulatory Care Unit. A power analysis determined the sample size of 63. Two methods were used: a two-sample proportion test comparing Press Ganey® top box scores before and after the intervention, and comparison of three specific survey questions related to anesthesia and recovery. Additionally, nurses conducted post-operative calls 24–72 hours after discharge, documenting yes/no responses and patient recall of side effects and recovery instructions. Staff were trained using teach-back method. Patients received discharge teaching prior to receiving any sedation and prior to discharge using the teach-back method. Patients received standardized discharge materials. Data was collected via surveys and phone calls. Findings were shared internally and externally to support future improvements in discharge education and patient comprehension.

Findings

The primary outcome of this project was feedback from post-operative phone calls conducted by nurses revealed high levels of understanding, with over 90% of patients affirming clarity in discharge instructions, and over 70% of patients could recall two anesthesia side effects using the teach-back method. Press Ganey® surveys, focusing on top box scores and three anesthesia-related questions, showed no significant statistical change. Patient responses to questions about anesthesia information, side effects, and recovery instructions remained relatively consistent across both time periods according to the Press Ganey®. Challenges included limited access to raw survey data, staffing shortages, and leadership transitions, which impacted morale and project execution.

Practice Implications

This initiative aimed to enhance patient comprehension of discharge instructions, particularly regarding anesthesia recovery. Despite early momentum, several obstacles emerged. Staffing shortages due to unexpected absences reduced time for patient education, and administrative changes created uncertainty among staff. Limited access to raw Press Ganey^® data further hindered evaluation. Survey results from discharge phone calls did show patients understanding of their discharge instructions. Press Ganey® results did not show any improvement. The project revealed key barriers, including data limitations and operational disruptions. Future efforts should emphasize a more structured discharge process and stronger data collection methods to support ongoing quality improvement and measurable outcomes.

References

Alzahrani, H. M., Alsaleem, S. A., Abbag, L. F., & Salem, E. S. (2021). Assessment of patients’ comprehension of discharge instructions and associated factors. World Family Medicine, 19(4), 11–17.

Cook, J., Fioratou, E., Davey, P., & Urquhart, L.. (2022). Improving patient understanding on discharge from the short stay unit: An integrated human factors and quality improvement approach. BMJ Open Quality, 11(3), Article e001810. https://doi.org/10.1136/bmjoq-2021-001810.

Hahn-Goldberg, S., Huynh, T., Chaput, A., Krahn, M., Rac, V., Tomlinson, G., Matelski, J., Abrams, H., Bell, C., Madho, C., Ferguson, C., Turcotte, A., Free, C., Hogan, S., Nicholas, B., Oldershaw, B., & Okrainec, K. (2021). Implementation, spread and impact of the Patient Oriented Discharge Summary (PODS) across Ontario hospitals: A mixed methods evaluation. BioMed Central Health Services Research, 21(1), 1–14.