Joint Commission requirements for discharge instructions in patients with heart failure: is understanding important for preventing readmissions?

BACKGROUND: Many approaches have been considered to reduce heart failure (HF) readmissions. The Joint Commission on Accreditation of Health Care Organizations (JC) requires hospitals to provide patients admitted for HF with discharge instructions that address 6 topics related to HF management: diet, exercise, weight monitoring, worsening symptoms, medications, and follow-up appointments. These guidelines were developed based on expert opinion, but no one has tested whether patients' understanding of these instructions affects 30-day readmission rates. METHODS AND
RESULTS: We conducted a prospective cohort study of patients admitted for decompensated HF. Patients completed an understanding survey immediately after their nurse read their discharge papers. The survey contained 1 question for each of the 6 JC topics. Of the 145 patients in the study, only 14 (10%) understood all 6 discharge instructions. Patients with complete comprehension of their discharge instructions were significantly less likely to be readmitted within 30 days than those with nonperfect understanding (P = .044), but this association was no longer significant after controlling for level of education and use of English as a primary language.
CONCLUSIONS: HF patients' comprehension of discharge instructions is inadequate. Patients with limited education and those that do not speak English as a primary language are more likely to have poorer discharge understanding and higher rates of 30-day readmissions.