Client Comprehension of Discharge Instructions

In the Literature

Flegel T, Dobersek K, Bayer S, et al. Client's understanding of instructions for small animals in a veterinary neurological referral center. J Vet Intern Med. 2024;38(3):1639-1650. doi:10.1111/jvim.17085

The Research …

Client understanding of a patient’s medical condition, treatment provided, and therapeutic outcome goals can vary. Studies in human medicine suggest written instructions can improve at-home medication compliance rates from 40% to 71%.¹

This study used a 3-part questionnaire to investigate client comprehension of discharge instructions at a veterinary neurology referral center in Germany. Parts I and II consisted of demographic questions. Part III was completed by clients and clinicians (separately) on the day of discharge and again by clients 2 weeks later. Raw percent agreement (RPA) was calculated by dividing the number of questions with the same answers given by the client and clinician by the total number of questions. Total RPA was calculated as the mean of individual RPAs.

Of 230 clients who agreed to participate, 160 completed a questionnaire either at discharge or after 2 weeks, but only 70 (30.4%) completed part III at both time points. Thirty respondents (18.7%) owned a cat and 130 (81.3%) owned a dog. Total RPA was 68.9% and 66.8% at discharge and after 2 weeks, respectively. Three questions had significantly lower RPA after 2 weeks compared with at discharge: should you give any medication before feeding your pet, what are potential adverse effects of the medicine you have to give your pet, and if your pet has to live permanently with signs of the disease, which are those. Client age was the only factor that affected total RPA; significantly lower RPA was noted in clients >50 years of age.

… The Takeaways

Key pearls to put into practice:

• Clients who completed the questionnaire 2 weeks after discharge may have referred to discharge instructions. Results of the study support inclusion of a client-focused section on the discharge form, specifically instructions related to exercise, medication administration and adverse effects, signs of disease progression, and/or when to contact the clinic.

• To avoid overwhelming clients, verbal discharge instructions should focus on key ideas. A focused verbal discharge with frequent reference to full written discharge instructions may increase efficacy of communicating medical information. In one study, clients were 7 times more likely to make appropriate medical decisions when provided succinct information.²

• Client age, which can affect information recall, was the only factor that significantly affected total RPA in the study. Written and verbal discharge instructions should be provided to all clients and can be especially beneficial for information retention in clients >50 years of age.