At UF Health Shands quality-improvement initiative aims to simplify discharge instructions that patients receive before they leave the hospital.
“If patients don’t understand the discharge process, there is a higher chance of readmission to the hospital,’’ said Juan Mira, M.D., a UF College of Medicine department of surgery surgical research resident. Mira played a lead role on a multidisciplinary committee that revised the aftervisit summary, or AVS, for surgical and medical patients.
The new AVS, introduced about a year ago, is designed to provide patients with information about their stay or surgical procedure, how to care for themselves after discharge and who to call if there are questions or problems. The AVS also includes information mandated by the U.S. Centers for Medicare and Medicaid Services on topics including smoking cessation, heart attack, stroke awareness and suicide prevention.
The project involved input and coordination from nurses, case managers, medical interpreters and physicians.
While the previous AVS provided most of the necessary information, follow-up appointments and important phone numbers were hard to find. Instructions for self-care were buried in the document, and a significant amount of information — including medication lists — was redundant.
“We were getting a number of complaints from patients and nurses,” said Rhea Broyles, R.N., a UF Health Sebastian Ferrero Office of Clinical Quality and Patient Safety senior quality improvement specialist.
In the new template, information and instructions deemed most important by the care team — such as the reason for admission, specific instructions, phone numbers and medications — are now on the first page of the AVS. If a patient has a specific disease or disorder, additional information and instructions print out with the AVS.
“The AVS needed to be more personal so the patients felt like we were really talking with them and not just giving them a stack of paper,” said Cassie Marcelle, R.N., RN-BC, the UF Health Shands Nursing and Patient Service Nursing Informatics administrative director.
Revising the AVS also emphasized the importance of medication reconciliation from patient admission through discharge, said Ben Staley, Pharm.D., BCPS, a UF Health Shands Clinical Pharmacy Services clinical specialist in quality improvement and clinical decision support.
Additionally, UF Health’s medical interpreters identified errors in the lengthy AVS and brought potential patient safety concerns to the team that they had found when translating the documents into Spanish, said Anne Meiring, LCSW, CPXP, a UF Health Sebastian Ferrero Office of Clinical Quality and Patient Safety patient experience and language-access improvement specialist.
Mira said the new AVS is available for all discharges. He is currently working with residents from other disciplines to improve instructions for medical patients.
Clinicians with questions about the AVS can call the EPIC help desk at 352-265-0526. There is also a tip sheet available on how to fill out the AVS.