386 - Implementation of Teach-Back Method Strategies to Increase Parental Recall of Inpatient Discharge Instructions in a Pediatric Community Hospital

Poster Number: 386
Publication Number: 386.243

Luisa E. Misa, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Background: Elmhurst Hospital Center located in Queens, New York serves a highly diverse community where 65% of the population are foreign-born immigrants and 27% of adults over the age of 25 reported no formal education based on the 2019 US Census Bureau survey. Low levels of formal education and limited English proficiency are barriers to achieving health literacy, which is the capacity to understand health-related information resulting in informed healthcare decisions and actions.

Objective: This quality improvement project aims to address this issue by training pediatric residents to use the teach-back method when giving discharge instructions allowing repetition of instructions in the parent’s own words. The aim is to increase the parent’s recall of their child’s discharge diagnosis and medications by 15% and follow-up appointments by 5% from the pre-intervention baseline within a 12-month period in the pediatric inpatient floor.

Design/Methods: Strategies were implemented through plan-do-study-act (PDSA) cycles including: PDSA #1: train all floor residents to do teach-back using an interactive web-based training at teachback.org and posters in the work room; PDSA #2: include a teach-back phrase reminder in the discharge summary; PDSA #3: perform a validated Single Item Literacy Screen upon admission to assess need for teach-back; PDSA #4: include introduction of teach-back in floor team orientation. The residents would call parents 1-2 days after discharge and document parent recall of the patient’s diagnosis, medications and follow-up.

Results: Baseline data showed an average recall of 81% for diagnosis, 79% for medication and 92% for follow-up appointments. Within the timeframe, a total of 248, 276 and 297 responses for recall of diagnosis, medication and follow-up were collected respectively. Run charts created for each recall factor had a median of 100%. After PDSA#1, the recall goal percentages for all three factors were exceeded and mostly maintained throughout PDSA #2 and #3. PDSA #4 was implemented after a notable decrease in recall for all three factors. This corresponded to the time of the entry of new interns and a steady increase in the number of patient admissions after the first wave of the Covid 19 pandemic.Conclusion(s): Implementation of online teach-back training and posters with interventions to ascertain usage and recall of the technique among pediatric floor residents when explaining discharge instructions was able to successfully increase parent recall of their child’s diagnosis and medication by over 15% and their follow-up appointment by over 5% from the pre-intervention baseline.
Parental Recall of Diagnosis Run ChartParental Recall of Diagnosis Run Chart
Parental Recall of Medications Run ChartParental Recall of Medications Run Chart