Abstract Title

Teach Back, Don't Come Back: Reducing Readmissions Through Effective Discharge Communication

Background Patient and caregiver education at the time of hospital discharge is critical transitioning care, but is often ineffective. Barriers to discharge communication can include diminished functional capacity due to illness, socioeconomic factors such as inability to afford new medications, limited understanding of the expected progression of symptoms, and schedule incompatibility between patient caregivers and hospital staff. Increasing the quality of communication between physician teams and patient families at the time of discharge has the potential to improve patient outcomes and reduce readmissions.

Case Presentation Francesca (pseudonym) is an elderly woman with a history of stroke 15 years prior with residual speech and motor deficits. She is non-verbal and is cared for by her two daughters. She has presented to the emergency department several times in the past two weeks for altered mental status, and was incidentally found to have a positive urinalysis, which was treated with antibiotics 1 week prior.

She is brought by her daughter today due to concern for altered mental status. Physical exam is consistent with her documented baseline since the stroke. A review of her medical history shows a pattern of hospital admissions for non-specific mental status changes over the past 6-7 years and a primary care note documenting a diagnosis of vascular dementia 8 years prior. The team concludes that Francesca’s family may be interpreting fluctuations in her status as new illness, when they are more likely chronic sequelae of her underlying dementia.

The treating team briefly met with one of Francesca’s daughters during morning rounds, and explained that her symptoms were consistent with vascular dementia. She was discharged later that day.

One month later, Francesca returned with both daughters due to mental status changes. Examination and imaging revealed no changes. One daughter recalled the prior admission, stating “When she was here one month ago, the doctors mentioned that this might be her new normal. I’m not really sure how to tell whether this is normal, or whether something concerning is going on.”

Discussion This case illustrates many challenges of effective discharge communication: only one of the patient’s caregivers was present, the conversation was rushed due to morning rounds, and communication was delivered primarily by the physician, with little time devoted to soliciting the family’s concerns or questions. In this instance, the family’s awareness of the expected course of symptoms was incomplete, and resulted in an unnecessary readmission.