Date of Conferral



Doctor of Nursing Practice (DNP)




Allison Terry


Patients with limited health literacy often fail to understand verbal and written discharge instructions, and they frequently return to the emergency department (ED) for care. Patients returning to the ED and 30-day readmission rate are core quality performance measures. The purpose of this project was to decrease repeat visits and readmissions to the ED by implementing components of health literacy programs within the ED on patient education and written discharge instructions. Change implementation consisted of (a) use of teach back method (b) modifying medical terminology to language that patient could understand (c) limiting use of words with more than three syllables and (d) discouraging nursing practice of copying and pasting other completed clinician notes in discharge notes. Following the tenets of the logic model and Watson's caring theory, ED nurses (n=45) at a veteran's healthcare facility participated in the modification of the ED discharge note design. A retrospective quantitative design was used to obtain data from 5,474 records related to each patient's language preference, educational level, and the readability index of the discharge note pre-and post-modification of the note. The comparative analysis of the descriptive statistics before and after modification of the discharge note indicated a decrease of 1.75% in the readability index of the discharge note, a 24% decrease in return visits within 30 days and a 40% decrease in readmission rate within 30 days. Healthcare costs and health disparities associated with health literacy decrease if patients comprehend discharge instructions. Understanding verbal and written discharge instructions correlates with healthy communities. Health literacy policies and technological innovation can promote health literacy and research on health literacy.

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Nursing Commons