Blog | Tuesday, July 14, 2015

The discharge paperwork makeover


It could be the title of a new primetime show (maybe it should be): The Great Discharge Paperwork Makeover. Assemble a group of bright and creative minds from across the country and put them together in an exotic location for a week to talk about something that will affect all of us one day—either ourselves or a relative. Task: Take the average tatty piece of paper that is given to patients when they leave the hospital and make it into something worthy of the great profession of medicine.

A bit of history first. Before electronic medical records became universally adopted, patients used to get a handwritten piece of paper when they left the hospital, usually within a set template. This was frequently illegible and far from optimal. Since the introduction of computerized discharge papers, sadly things have hardly got better. In most hospitals, patients receive printed pieces of paper in a dull typeface, often indecipherable using technical terms, with additional random information scattered across it.

The real-world implications of this are tangible at the coalface of medicine. Recently, I had just discharged a patient and was told by the nurse that the family was confused with the instructions that they had been given. I went to talk to the patient and the family, and when I saw the print out that was generated by the computer, I was quite shocked myself. The daughter, highly intelligent, then went on to describe in great detail what she thought was wrong with the paperwork—ranging from difficulty understanding the medications listed, to confusion about where to find the important information regarding follow-up. The type was also way too small for an older person to read. She described the paperwork looking as if the hospital “was careless”. By the end of her time talking, I was honestly left agreeing 110% with what she was concerned about, and couldn't help but to apologize for the state of the standard paperwork we use. In fact, I already knew many of the things she was worried about—I've seen the same problem in lots of different hospitals up and down the east coast.

But back to The Great Discharge Paperwork Makeover. The contestants should be a mixture of the sensible and creative. Clinicians, IT professionals, administrators, patient advocates and designers. They have one week to make a gold-standard template discharge paperwork that is eye-catching, logical, intuitive and makes it easy for anyone to read. It should be colored, have bigger writing, and plenty of space for all the important clinical information—especially the follow-up instructions. The prize for doing this: a big thank-you and blessings from the millions of discharged patients every year.

Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care. This post originally appeared at his blog.