Simplified patient dismissal instructions improve patient experience following robot-assisted radical prostatectomy

Aug. 21, 2021

In 2020, Madeleine G. Manka, M.D., chief resident in Urology at Mayo Clinic in Rochester, Minnesota, saw an opportunity to improve the patient experience in Mayo Urology by revising the instructions given to patients after surgery. Specifically, Dr. Manka and colleagues aimed to reconstruct patient dismissal instructions following robot-assisted radical prostatectomy.

"Research has shown that the contents of the dismissal instructions, while pertinent to helping patients' recovery, are often written with difficult-to-understand medical language and at a reading level that can be difficult for some patients to comprehend. In evaluating commonly used dismissal instructions provided to patients following robot-assisted radical prostatectomy at Mayo Clinic, we identified instructions that could be improved to help patients navigate the acute postoperative period after dismissal from the hospital," says Dr. Manka.

Dr. Manka, working with a multidisciplinary team and under the mentorship of Brian L. Linder, M.D., a urologist at Mayo Clinic in Minnesota, revised the hospital dismissal instructions given to patients following prostatectomy as follows:

  • The reading level was decreased from a 13th grade level at baseline to a seventh grade level.
  • Many difficult-to-understand medical terms were replaced with language that could be understood by patients without a medical background.

Of 110 patients included in the study, 60 patients were provided with the original dismissal instructions and 50 patients were provided with the revised, easier-to-understand dismissal instructions.

After instituting the new postoperative dismissal instructions for patients receiving robot-assisted radical prostatectomies, Dr. Manka and her colleagues reviewed whether patients provided with the updated instructions felt less of a need to contact their care teams with clarifying questions compared with patients who received the earlier version of dismissal instructions.

The research team compared patient-initiated telephone calls and online messages, unplanned clinic visits, readmission rates, and emergency department visits. After revision of the dismissal instructions the number of patient-initiated messages (per patient) decreased significantly (mean 2.3 vs 1.4; p = 0.02), and patients who received the new dismissal instructions were significantly less likely to have an emergency department visit (20% vs 4%;p = 0.02). There was no difference in the rate of readmission to the hospital (p = 1.0).

"Based on this study, we concluded that improved readability of hospital dismissal instructions was associated with significantly lower rates of patient-initiated messages and emergency department visits," says Dr. Linder. "Furthermore, improving the readability of postoperative dismissal instructions represented a valuable opportunity for improving the quality of patient care and decreasing postoperative care burden on the wider health care system."

Other groups within Urology at Mayo Clinic in Minnesota have taken the opportunity to reassess the readability of dismissal instructions for other urologic surgical procedures, including surgical procedures that require ureteral stent placement.

"By making easier-to-understand postoperative dismissal instructions for patients, we can improve patients' overall operative experience and allow patients to feel more comfortable transitioning from the hospital to home," says Dr. Manka.

The study results were published in Urology in 2021.

For more information

Manka MG, et al. Assessing the impact of hospital dismissal summary readability on patient outcomes following prostatectomy. Urology. In press.