Adjusting the Discharge Process for Improved HCAHPS Scores

The unfortunate truth is that no patient wants to be in your hospital and everyone is focused on going home.

There are five questions on the HCAHPS survey dealing with the discharge home, or the transition of care, and they all center around the patient’s level of understanding of their discharge instructions and your staff’s level of understanding of patient preferences. For improved HCAHPS scores, we need to recognize a problem with the discharge process: we, as health care providers, have designed the process for us and not for our patients.

Start at Admission

Patients need discharge information sooner than the last day of their stay. Why not start the process at admission? Start talking immediately with your patients about: 

• Who are they going home with?
• Who is their primary caregiver?
• Do they need equipment?
• Do they need extra help?

These questions should be addressed right from the beginning of their stay.

Written Instructions

Every facility has a written packet of discharge instructions that includes precautions for going home and information on medications. This critical information should be presented at the beginning of a patient’s stay so that more education can take place and any questions that come up can be answered long before the patient walks out the door.

It’s true that medications can change toward the end of the stay, but why not start by giving them the precautions for the surgery that we know they’ve already had? Give them information on the medications we know they’ll be going home with, and not just for them to have it, but for us to reference it. Every time staff visits the room to discuss and administer a medication, it’s a great opportunity to pull out the discharge information.

Ideally, at the hour of discharge, the patient should be able to tell you about their precautions and medications rather than the other way around.

Proven Process

The discharge process should be repeatable for every patient, every time. Yes, discharge instructions should be discussed throughout the entire stay, beginning at admission, but at that moment of discharge there are six main steps that should be followed:

1. Discuss the diagnosis.
2. Follow up with any treatments that were done and the results of those treatments.
3. Go over any test results.
4. Discuss any symptoms that they can look for when they go home.
5. Discuss any follow-up appointments.
6. Go over instructions on any medications that will be taken at home. Medication Communication is a primary focus of the HCAHPS survey.

This is a process (for patients and improved HCAHPS scores) that should be repeated for every patient at every discharge, but more importantly, remember to start discharge planning at admission, and keep the conversation going throughout the entire stay.