Digital checklists at discharge may improve patient engagement, outcomes

Doctor patient

Discharge instructions offered to patients are often generic and ambiguous. One way to improve outcomes and communication with patients is to provide them with more personalized checklists before they head home.

Paper checklists, though, may not be the best strategy, according to a blog post from NEJM Catalyst, and instead providers should opt for digital solutions that physicians can customize for each patient. But this will require a culture change, write Peter Pronovost, M.D., Ph.D., director of the Armstrong Institute for Patient Safety and Quality at Johns Hopkins; Asad Latif, M.D., assistant professor of anesthesiology and critical care medicine at Johns Hopkins; and Adil Haider, M.D., a trauma and critical care surgeon at Brigham and Women’s Hospital.

Physicians also must consider health literacy when they customize checklists, according to previous research, which noted that 65 percent of the nearly 500 trauma patients studied had functional reading skills at grade levels below what is required to understand the discharge notes. Discharge notes should be understandable for those reading at a sixth-grade level, that study found.

But in the recent blog post, the authors say that customizable "smartlists" that patients can access have been linked to a decrease in the number of emergency room visits after surgery, cancelled operations, and the amount of time that office staff spend with patients on the phone. 

“Doctors need to encourage dialogue with patients, and patients need to feel engaged in their own care,” they wrote. “There is also an information gap: information is frequently siloed, and peer-learning communities, which have a vital role in reducing healthcare–acquired infections, are largely absent.”