Patients overestimate how well they recall diagnoses, care after discharge: study

Most hospital patients say they can remember details about their care and post-discharge instructions, but in reality their ability to recall within a day or two of leaving the hospital shows substantial room for improvement, according to a recent study.

Among a sample of 53 patients interviewed by University of Michigan School of Medicine researchers, nearly 91% said they could confidently recall their diagnoses and about 98% said they remembered their treatment.

Referencing their charts revealed correct recall of diagnoses among 58.5% of the patients, partial recall among 35.9% and incorrect recall among 5.7%, researchers wrote in the February issue of The Joint Commission Journal on Quality and Patient Safety.

Treatment recall was broken down into three categories—treatment during hospitalization, planned treatment after discharge and medication changes.

The former of those showed correct recall in 64.2% of cases, partial in 28.3% and incorrect in 7.5%.

For post-discharge treatment, researchers found 50.9% of correct responses, 43.4% of partially correct and 5.7% incorrect. Medication changes were the worst recalled domain, with 43.4% fully correct, 32.1% partially correct and 24.5% incorrect, they found.

“Patients’ overall recall of care related to hospital admission remains poor despite patient perception of thorough understanding and current hospital interventions to enhance care knowledge retention,” the researchers wrote in the journal. “Significant improvements to help patients retain care knowledge are needed, given the increasing complexity of care, an aging population and the clear benefit of patient comprehension in reducing readmission rates, increasing satisfaction and improving self-care.”

Recall across the four measures “was surprisingly similar” when comparing those older and younger than 65, the researchers wrote, though length of stay revealed back-and-forth differences in recall rates that were difficult to explain.

The researchers also reviewed whether certain in-hospital and outpatient information facilitators, such as whiteboards, discharge paperwork and patient portals, were used and were helpful.

Patients most often pointed to discussions with their medical providers (66%) and prior personal experience in the medical field (22.6%) when given an open-ended question about what helped them retain information. When prompted with specific examples of facilitators, they most often said they used whiteboards (96.2%), discharge paperwork (88.7%) and the patient portal (73.6%).

Researchers then asked patients which of the facilitators was most useful. Patients gave the strongest feedback to conversations with their physician (94.3% positive) and the nursing staff (92.5% positive), while whiteboards were rated significantly lower than all other facilitators (35.8% positive).

Suggestions from the patients on how to better aid understanding included more face time with providers, access to note-taking materials, patient-friendly charting changes in the electronic health record and reducing unnecessary data in discharge paperwork.

“Patient education and engagement is considered a key component of transitional care efforts, leading to the development of standardized discharge instructions and patient-centered discharge tools,” Blair P. Golden, M.D., of the University of Wisconsin-Madison, and Karen Okrainec, M.D., of University Health Network, wrote in an accompanying editorial. “Health systems must proactively address disparities that exist with regard to patient and caregiver engagement surrounding care transitions, in addition to broader structural determinants of health that have been shown to contribute to health outcomes.”

Researchers conducted their single-center study among patients admitted to a general medicine resident teaching services from May 12 to June 20, 2021. An initial 375 discharges were whittled down to 53 due to exclusion criteria, patient consent and loss to follow-up. Interviews were conducted over the phone within 24 to 48 hours of discharge and responses were graded as correct, partially correct or incorrect by reviewing patient charts.

The researchers noted that their reported recall rates could be somewhat inflated due to their study criteria and interviewing process, which likely were biased toward patients who were more engaged in their care.