Enhanced readability of discharge summaries decreases provider telephone calls and patient readmissions in the posthospital setting

Introduction Hospital discharge instructions provide critical information necessary for patients to manage their own care; however, often they are written at a substantially higher readabilitylevel than recommended (ie, 6th-grade level) by the American Medical Association and the National Institutes of Health. We hypothesize that improving the reading level of discharge instructions will decrease the number of patient telephone callsand readmissions in the posthospital setting. Methods We conducted a prospective observational study. Patient discharge instructions were edited and incorporated to enhance the readabilitylevel in August 2015. Return telephone calland readmissions of patients admitted before the intervention from August 1, 2014, to January 31, 2015, were compared with the prospective cohort studied from September 1, 2015, to September 30, 2016. Results A total of 1,072 patients were included (preintervention: n  = 493, postintervention: n  = 579). Patient demographics, injury characteristics, and education level were similar among both groups. The median discharge instruction readabilitylevel in the postintervention group was significantly lower (10.0, 95% CI 10.0–10.2 vs 8.6, 95% CI 8.8–8.9; P P P  = .002). The proportion of patients calling and readmissions for poor pain control significantly decreased after the intervention (7.1% vs 2.59%; P  = .0005 and 2.8% vs 1.0%; P  = .029, respectively). Conclusion Enhanced readabilityof discharge instructions was associated with a decrease in the number of telephone callsand readmissions in the posthospital setting, enhancing health literacyand simultaneously reducing the burden on providers. Improved patient instructions written to an appropriate level may also allow for better pain control in the posthospital setting.