News & Commentary

Discharge Notes Confuse Patients


Only 1 in 4 patients sent home from hospitals have reading skills that would allow them to follow discharge instructions, according to a study in the American Journal of Surgery. The problem is probably worse, because patients who use English as a second language were not included in the study. Poor health literacy adds more than $73 billion to the national health care tab each year, Mayo Clinic researchers noted.

HHS, NIH, and the American Medical Association say that for the average adult to understand discharge instructions, they should be written at the sixth grade level.

Mayo Clinic researchers looked at 497 patients admitted for trauma from Aug. 1, 2014 to Dec. 31, 2014, and examined their discharge notes using the two standard scales of reading level.

One of the reasons for confusion is that discharge notes are aimed at two different audiences—patients and their doctors. Patients should be told what information is meant for them and what’s meant for their doctors, say the authors. In addition, there should be a clear demarcation indicating who is meant to read what.

The study states that the “average dismissal note requires reading skills of a college graduate… Adults, on average, read five grade levels lower than the highest educational level obtained.” In this study, 65% of patients had functional reading skills lower than the grade level at which the note was written.

Specialists might need to be more cognizant of the problem. The study states that discharge notes written in the trauma center were more likely to fit the patient’s comprehension ability than those written by non-trauma center personnel “likely due to the use of more complex terminology in the more specialized fields. As a result, we recommend that health care providers explain terminology in their respective fields to aid in patient comprehension.”

There’s also the matter that patients discharged from a hospital are usually far from 100%. Martin Zielinski, a trauma surgeon at Mayo and one of the study’s authors, told Reuters that “even if patients believe they understand what occurred during their hospitalization and the instructions they are to follow upon dismissal, they can become confused after they leave the hospital environment as their memory can be clouded by medications they were administered, the stress of hospitalization, and, particularly within our patient population, traumatic brain injuries such as concussions.”

But note this: The researchers did not actually measure the reading skills of the patients. Instead, they were inferred from education levels, and some people might read at a higher level than their educational level might suggest. Moreover, education level information was available for only 314 of the nearly 500 study participants.

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