By Christine Whitmarsh, RN, BSN
Patient discharge teaching is one of the most important parts of the cycle of care and by no means is it the end of the care plan. Unfortunately due to short staffing, heavy patient loads and all around time management issues, discharge teaching can turn into skimming through the discharge papers, hurriedly asking the patient and their family if they have any questions and getting their signature on the dotted line. The signature is intended to indicate their understanding of the instructions for follow-up and transition care. According to a well-publicized study by the New England Journal of Medicine earlier this month, however, there may be more signing than understanding happening as patients are leaving the hospital. The study revealed that 1 out of every 5 Medicare patients is back in the hospital within 30 days of being discharged (1 in 3 within 90 days).
Many different reasons for the readmissions were cited, including lack of a primary care physician outside the hospital, nosocomial infections presumably acquired during their initial stay and the basic fact that elderly patients are increasingly suffering from a mixture of conditions and diagnoses. If Medicaid coverage was designed to make patients completely “well” again, it would likely be facing even more financial challenges than it already is.
Those are factors are somewhat less controllable than the patient discharge teaching component, also mentioned in the study. It would be turning a blind eye if the connection between the nursing shortage and the time required for adequate patient teaching was not addressed. When there are not enough hours in a shift and not enough of you to go around, it’s easy to see a discharge as one less patient to take care of. This may seem somewhat heartless, but as the staffing shortage increases, so does the challenge of prioritizing patient care. The travel nursing industry is making great strides in helping hospitals (or in some cases loudly offering help) with staffing shortages. Travel nurses can be the difference in nurse to patient ratio that allow patients to receive the discharge teaching they need to avoid readmission due to misunderstanding of the treatment regimen.
Christine Whitmarsh is a Registered Nurse with a BSN from the University of Rhode Island. She is a freelance health journalist and medical writer and a contributor to Travel Nurse Source and Allied Travel Careers.