Discharge instructions are the written and spoken plan a patient takes home: what happened, which medicines to take, what to watch for, and who to call. What goes into them can vary from one hospital to the next.
What the federal rule covers
For hospitals in Medicare, discharge planning falls under 42 CFR 482.43. The rule requires hospitals to include patients and their caregivers or support persons as active partners in discharge planning, to discuss the results of the discharge planning evaluation with the patient or their representative, and to send the necessary medical information to the providers responsible for follow-up care.
What this section does not do is spell out the content of patient education. It sets the process, not the actual words, format, or level of detail a patient receives.
A tested framework for the content
The Agency for Healthcare Research and Quality publishes the Re-Engineered Discharge (RED) toolkit, developed and tested by researchers at Boston University Medical Center. Its in-hospital components include:
- Checking the discharge plan against national guidelines
- Confirming the correct medicines and how the patient will get them
- Following up on tests or labs still pending at discharge
- Arranging equipment and services needed at home
- Teaching the written plan in plain language
- Assessing how well the patient understands it
- Reviewing what to do if a problem comes up
The toolkit includes a written After Hospital Care Plan the patient takes home and a follow-up phone call after discharge. AHRQ states that research showed the RED reduced readmissions and post-hospital emergency department visits.
Checking that it landed
Several of those components depend on the patient understanding the plan once they have it. AHRQ's teach-back guidance describes asking patients to explain, in their own words, what they need to know or do. It recommends avoiding yes-or-no questions such as "Do you understand?" because patients often say yes either way, and checking understanding in small pieces rather than all at the end.
A practical checklist
- The diagnosis, in plain words
- Every medicine: what changed, the dose, when to take it, and how to get it
- Follow-up appointments and pending results
- Warning signs, and exactly who to call for each
- Equipment or home services, and when they arrive
- A check, in the patient's own words, that the plan was understood
Written instructions can be paired with a short video the patient or family can replay at home, for example through a QR code on the paperwork. Qik Productions makes those videos to match a hospital's own instructions. See how it works.
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