5 Discharge Strategies to Reduce Postop Readmissions

Educating postoperative patients recovering from an anesthetic is a challenge on several fronts.

“It’s a double-edged sword sometimes as nurses work to optimize a patient’s length of stay while also making sure the patient and their family members truly understand discharge instructions and their responsibilities for home care,” says Marianne McAuliffe, DNP, RN, perianesthesia educator at Beth Israel Deaconess Medical Center in Boston.

McAuliffe works closely with nursing staff to optimize discharge policies and practices addressing standardized information. She also works with nursing staff to assess needs for tailoring postoperative discharge education to make sure patients will be able to fully comply with discharge instructions.

This understanding can make the difference in a patient’s recovery, according to a recent study showing postoperative patients uncertain about aspects of their discharge instructions are more likely to develop a postoperative complication that leads to readmission.

Reducing Patient Uncertainty

While perioperative nurses don’t always have direct knowledge of a postop patient being readmitted, McAuliffe says “there are certain risks on our radar we know are challenging for patients to understand and comply with.”

Here are five strategies she encourages within her team to improve patient compliance with common discharge challenges patients experience:

1. Make a Preoperative Connection

   Patients may face challenging postoperative tasks, such as learning to ambulate with crutches. Starting this education early in the perioperative process may improve patient confidence and outcomes, McAuliffe says.

   She suggests this education ideally begins in the surgeon’s office to give patients the opportunity to understand their expected mobility limitations.




2. Understand How Patients Learn

   Understanding how a patient learns will assist the nurse in providing postoperative education in an appropriate way. A family member or designated support person may be involved to reinforce discharge education, McAuliffe notes.

   When there is a language barrier, an interpreter should be arranged prior to surgery so communication can be reinforced before and after surgery.




3. Use Tools to Demonstrate the Reasons for a Safe Approach

   Diagrams and equipment may be employed as part of the teaching strategy. Patients being discharged who will remove a Foley catheter, for example, receive verbal and written instructions that include a diagram showing the placement of a catheter in the bladder, McAuliffe explains. The patient also practices using a syringe to deflate the balloon of a catheter before discharge.




4. Take Time for Teach-Back

   Ensuring that patients understand their discharge instructions is critical and a standardized communication process that includes teach-back can enhance learning, McAuliffe suggests. “Patients may say they understand their instructions and utilizing teach-back communication is one method nurses can use to validate what the patient has understood.”

   For example, patients are asked to explain how they will ambulate following a femoral nerve block which allows for modifications and reinforcement of the discharge instructions to prevent a patient fall.




5. Don’t Be Afraid to Involve the Surgeon<

   Surgeons and nurses should have a shared understanding of postop teaching and should have open communication to discuss questions on a case-by-case basis, she says. “If there is a concern, our nurses feel very free to talk to a surgeon and invite them to speak with a patient regarding discharge questions. McAuliffe sees this collaboration as part of a strong safety culture.

“Our nurses are empowered to advocate for their patients by going that extra mile with engaged postoperative discharge teaching.” 

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