Structured discharge education improves early outcome in orthopedic patients

Background: Optimally efficacious patient education at discharge is a challenge for medical staff, patients and the patients' families. The unique fears and concerns associated with discharge to the community and the self-care of orthopaedic patients must be dealt with as well. The instructions given at the time of discharge could influence the perception of and overall satisfaction levels of patients when related to their hospital experience. Objective: To assess the impact of structured, compared to standard patient education, at the time of hospital discharge. Methods: Orthopaedic patients given structured (n=47, Group 1) or standard (n=48, Group 2) instructions at discharge were compared. The nurses used specially designed booklets containing relevant questions and answers to guide them in providing instructions to Group 1. Six weeks after discharge, all patients were interviewed via the telephone regarding their satisfaction levels in relation to their hospitalisation, pain management, functional status and compliance with follow-up visits. Results: Group 1 patients had fewer pain complaints (23, 48%) compared to Group 2 (34, 70.8%). Their follow-up compliance was also higher (44, 93.6% versus 37, 77.1%) and they reported greater satisfaction from the nurse-patient communication and discharge instructions (19.4 and 11.5) than Group 2 (17.8 and 9.7). The number of unplanned medical visits (to emergency services or general practitioners) after discharge was similar for both groups. Group 1 had better functional status as measured by activity of daily living and instrumental activity of daily living indices. Discussion: Structured patient education at discharge offers an easily implemented alternative to standard instructions and improves patient satisfaction, pain management, compliance with follow-up and better functional status.