Robert Linsky has been an Information design practitioner for over 25 years. Currently Information Design Doc and Director of Information Design at NEPS, LLC. www.neps.com,
Member of the International Institute for Information Design (IIID) www.IIID.net,
Life Fellow of the Communications Research Institute (CRI) www.communication.org.au,
Member of Information Design Association (IDA) www.informationdesignassociation.org, Board member of PLAIN http://www.plainlanguagenetwork.org,
Director of Judging for the ClearMark Awards of the Center for Plain Language (CPL) www.centerforplainlanguage.org.
Editorial Board Member, Information Design Journal.
Former Board Member and Chair, Massachusetts College of Art and Design Board of Trustees.
Black Monday, the Day CMS Readmission Reduction Program became effective
Stay away, we don’t want you!
That‘s what hospitals are telling their patients as they get discharged.
Readmissions to the hospital for certain conditions are becoming very expensive. Under the Affordable Care Act, hospitals are now getting penalized for readmission for heart failure, heart attacks or pneumonia, with more conditions being added in future years. This year 2,217 hospitals will be penalized resulting in $280 million dollars being returned to Medicare. That doesn’t include any state penalties they might incur.
Again – why? The federal government found out that nearly one in five Medicare patients return to hospitals within a month of discharge and it cost the government an extra $17.5 billion in 2010.
That’s right, billion with a “B”!
To help reduce readmissions, hospitals are becoming more pro-active after discharge by implementing outreach programs to ensure patients get follow up appointments, take their medications regularly after returning home and sending nurses to visit patients at home.
But, while hospitals are trying many different approaches with varying degrees of success, one area often over looked is the discharge process itself and the paperwork that accompanies the patient home. If you or a family member has had a hospital stay, you have seen various flavors of discharge instructions. While we here at NEPS cannot follow a patient home and help with medications (we’d like to, but we don’t have the skills or license), we use our expertise in clear communications and information design to make documents easier for people to understand and follow. The result is not only better for the patients and caregivers, but for hospitals too. Simple instructions may help lower the cost of the post-discharge follow-up process.
Here are two examples:
First, the following is a section from a seven-page discharge form that tells the patient about the blood clot medicine they are taking home. At quick glance, it looks like four bullets, but the fourth bullet (10 lines) includes the time and place of your next test and the name of your physician. The text all runs together with no visual separation and is the same font and same point size, making it hard to read and more crucially, find important information. The testing/contact information is lost.
Think about a patient as they are being discharge from the facility and meeting with a nurse who is going over seven pages of information. The patient may still be suffering from the effects of the procedure or medication and might not be fully aware. Maybe there is a family member also in that meeting. But that family member might not be with the patient 2, 3 or 4 days after when the patient needs to refer to the discharge papers. It will be difficult trying to weed through seven highly illegible pages.
Now look at the revised sample.
Notice the use of different types of fonts– bold and light – to distinguish information and allow the eye to find relevant groups of content. In addition, the proper use of white space creates separation so the eye can focus on each group and quickly and easily find the appropriate information.Here too, a larger font size is used, making readability easier even for olderor visually impaired patients. This is all accomplished while taking up lessspace on a page thus giving the patient fewer pages to read. Together, all these factors can help improve the chances of success in keeping patients from being readmitted.
Equally as critical in this type of document is the order in which informationis provided. We recently reviewed a card sent home with a chemotherapypatient to help them understand and manage the after effects. The first item on the 5 ½ x 8 ½ sized card was:
“How it is given: Into the vein”
This information is entirely irrelevant in this context and yet it is given the most prominent position on the card. What is relevant is what side effects can be expected, a list of symptoms that should prompt a call to your doctor,and a list of recommended behavior or things to avoid. Fully half of thisinformation was on the back of the card, including all the information aboutwhen you should call your doctor. The very last bullet on the back side of thecard was a warning about avoiding the use of “aspirin or aspirin containingproducts”. Since this is a common OTC medication that many use withoutthinking, and taking it can lead to complications for some, this warning shouldbe much more prominent.
Ultimately, we designed the card to look like this with all information on oneside and the most critical having the most prominence.
Although the penalties are capped at 1% this year, they will go up to 2% nextyear and 3% the following year. Hospitals must do whatever they can to minimize the penalties, but also improve healthcare and reduce medical errors. While outreach programs and personal visits and phone calls can prove effective in preventing readmissions, they are expensive and not always available at the exact time they are needed. Why rely solely on multiple people and processes as a costly band-aid (pun intended!) on the post-discharge end when clear communications can result in increased understanding of and adherence to follow-up activities?
In our own way, we are playing an important role in making information
clearer, readable and easier to understand for all involved, while cutting
down on preventable post-hospitalization complications.