Journal Article

Evaluating the quality and equity of patient hospital discharge instructions

Lanney, Howard, Rapoport, Victoria Oliva, Jack, Brian W., Wornhoff, Rebecca, Austad, Kirsten, McDaniel, Katherine, Li-Garrison, Lindsay, Lee, Joo Hyun

2025

Overview

Background Written discharge instructions improve patient understanding and self-management after hospitalization. While a small number of studies have evaluated the quality of hospital discharge instructions, none have focused on patients with a non-English language preference (NELP) or looked for potential disparities. Our goal was to compare the quality of patient discharge instructions between those with English language preference and NELP, including whether instructions were in the patient’s preferred language, included all content domains recommended by professional groups, and followed best practices for health literacy. Methods We analyzed 200 discharge records from inpatient adult medicine discharges at one hospital across a range of diagnoses using case matching by diagnosis and age to construct an English and NELP cohort (each n  = 100). We assessed the percentage of discharge instructions written in the patient’s preferred language, measured word count, and calculated readability scores. Lastly, two individual raters used a scale—the Quality of Discharge Instructions-Inpatient (QDI-I) scale—to rate them across six domains of content quality. Results Only 8% of patients with NELP received discharge instructions in their preferred language compared to 100% in the English cohort ( p  < 0.001). The mean overall QDI-I score was similar for the NELP and English cohorts (71.1% of perfect versus 71.3% of perfect, p  = 0.92), but the domain of return precautions was inferior among those with NELP (80.5% of perfect vs. 88.8% of perfect, p  = 0.013). Instructions in both groups were written at an eighth- to ninth-grade reading level (age 13–15). Discussion We found disparities in quality of written discharge instructions for patients with NELP. Recommended next steps include replication of our methods across health systems and larger sample sizes to examine differences between non-English language groups.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Admission and discharge / Adult / Aged / Analysis / Communication Barriers / English as a second language / Evaluation / Evidence-based medicine / Female / Health Administration / Health Informatics / Health Literacy / Heart failure / Hospital discharge / Hospital patients / Hospitals / Humans / Language / Limited english proficiency / Male / Medical diagnosis / Medicine / Medicine & Public Health / Middle Aged / Non-English language preference / Normal distribution / Nursing Research / Patient Discharge - standards / Patient Discharge Summaries - standards / Patient education / Patient satisfaction / Public Health / Quality management / Transitions of care