Hospital Discharge Instructions using Mind Mapping

HOSPITAL DISCHARGE INSTRUCTIONS USING MIND MAPPING
Image courtesy of cooldesign at FreeDigitalPhotos.net
(c) Infoseg, S.A. 2016 http://bit.ly/1Eimh3k 1

Vulnerability of Patients after Hospital Discharge
Image courtesy of Stuart Miles at FreeDigitalPhotos.net

Vulnerability of Patients after Hospital Discharge [1]
• About half of the adult patients, experience at least
one medical error after a hospital discharge. [2]
• Between a 19 and a 23% suffer an adverse effect
after discharge, most of the times related to
medication. [3-5]
• When there are adverse effects, 66% are related to
medication, 17% to procedures. [4]

Adherence of Patients to Discharge Instructions
Image courtesy of dan at FreeDigitalPhotos.net

Factors that influence conformity and satisfaction of
the patient with the post-discharge plan [6,7]
• Amount of information
• Quality of the information
• Capacity of the patient to understand the
information

Study investigating patient perceptions of the quality
of discharge instruction 1997-2001 [8]
• Patient satisfaction decreased significantly every year.
• Patients gave lower ratings to the quality of discharge
instruction than to the overall quality of their hospital stay.
• Patient assessments of discharge instruction quality varied
systematically among conditions

Main areas of non-compliance with discharge instructions
• Medication
• Cures
• Medical appointments
• Diet
• Exercise
• Habitual behaviors

Quantification of Patient’s Adherence to Medical Recommendations [9]
• Average: 75%
• Minimum: less than 50%

Consequences of non-adherence to medical recommendations
• Unnecessary phone calls
• Unnecessary visits
• Delay in rehabilitation
• Unnecessary readmissions
• Unnecessary relapses
• Superfluous medical costs Image courtesy of ddpavumba at FreeDigitalPhotos.net

Problems when discharge
instructions are too simple
or incomplete
Image courtesy of Mister GC at FreeDigitalPhotos.net

If discharge instructions are too simple or incomplete, patients
look for complementary information through
• Relatives
• Friends
• Newspapers and
magazines
• Internet
Image courtesy of franky242 at FreeDigitalPhotos.net

The Toronto Consensus [10]
• “Effective communication between doctor and
patient is a central clinical function that cannot be
delegated.”
If the patient has to look for the information she needs
through relatives, friends, internet or any other non
reliable source, effective commnication is interrupted.

Shortcomings of Health Information on the Internet [11]
• Uneven quality of medical information available.
• Difficulties in finding, understanding and using this
information.
• Lack of access for the unconnected population.
• The potential for harm and risks of overconsumption.

Image courtesy of Stuart Miles at FreeDigitalPhotos.net
Problems when discharge instructions are complex

Main problems when discharge instructions are complex [12]
• Inadequate health literacy of patients and relatives.
• Unrecognized cognitive impairment of patients.
• Linear text is very difficult to understand when it is
extensive, even for people not affected by any of the
two previous problems.
• Difficulty in memorizing the combination of verbal and
written instructions. [13]

IMPROVEMENT OF THE DISCHARGE
INSTRUCTIONS
Image courtesy of renjith krishnan at FreeDigitalPhotos.net

Use of images. Study 1. [14]
• The patients given cartoon instructions were more likely to
have read the instructions (98% versus 79%)
• More likely to answer all wound care questions correctly (46%
versus 6%)
• More compliant with daily wound care (77% versus 54%)

Use of images. Study 2 [15]
50% improvement in the comprehension of
instructions.

Standardized Electronic Discharge Instructions [16]
• Implementation of standardized electronic discharge
instructions was not associated with reduction in post-
discharge hospital utilization.
• More studies are needed but simply using electronic
discharge instructions does not solve the fundamental
problems.

The main problem
• If the discharge instructions are short and simple,
they cannot include all needed information.
• If the discharge instructions are complex and
extensive, patients cannot assimilate all the
information due to the limitations of linear text.
• The consequence is that patients cannot be
empowered.

The biopsychosocial model and the discharge instructions [17]
• Discharge instructions have to be adapted to the new
biopsychosocial model.
• This is needed in order to empower the patient.

Mind mapping in the
biopsychosocial model as a tool
to empower the patient
Image courtesy of Salvatore Vuono at FreeDigitalPhotos.net

The Mind Mapping technique [18]
It is a graphical technique for the
vualization of hierarchical connections
beween several elements of information.
Each element of information is linked
with other elements through lines,
creating a network of relations. They are
always organized around a single central
idea or information.
A mind map is a diagram created using
this technique.

Most important characteristics of mind maps
Fast processing of images in the brain
+ Hierarchical organization
+ Chunking of information
+ Whole picture and detail views at the same time
+ Visible relationship between the parts
+ Collapse / Expansion of the branches
+ Use of color (facilitating grouping)
+ Multimedia (text, images, documents, videos, sound)
+ 1 single compressed file, easy to send by email or FTP
+ Collaboration (online and presential)
+ Autoformatting
+ No need to change from one screen to another (no context loss)
+ Less mental fatigue
+ Easy to create, visualize and edit
+ The most important information is at the center (better vision)

Prototype of discharge instructions mind map

A mind map is a single compressed file
that can include the following elements:
• Shoft texts
• Free text Notes
• Icons
• Images
• Spreadsheets
• Charts
• Internet hyperlinks
• Hyperlinks to other mind maps
• Attached files of any type:
• Images
• PDF
• Word
• Excel
• Videos

Mind maps only need a free viewer (MindManager)

or a browser (HTML5)

Environments
Mac
Windows iPad, iPod, iPhone Android
Web

Attached PDF containing the detail of the instructions as linear text

Introduction to Discharge Instructions

Ho to get to the hospital

Wound care

Medication (With a free text Note)

Precautions

Exercise

Feeding (with attached video)

Follow up

Advantages of mind maps as discharge instructions
• Visual.
• Easy to use by the patient.
• No limit to the amount of information.
• All information on a single screen. No screen changes.
• All types of multimedia elements.
• Reduce / eliminate communication errors.
• Reduce / eliminate the problems of linear text o web
pages.
• Easy to send and visualize.
• Small size.
• Free viewer.

How are mind maps created?
• By automation from information contained in data bases.
• Can be personalized for each patient from her Personal Health
Record.
• Software developed in C#.NET for Windows.
• After being created, the mind map can be sent as an attached
file by email or FTP’s to a web page to be downloaded by the
patient.

References
[1] Kripalani S, Jackson AT, Schnipper JL, Coleman EA. Promoting effective transitions of care at hospital
discharge: a review of key issues for hospitalists. J Hosp Med. 2007;2:314–323.
[2] Moore C, et al., Medical errors related to discontinuity of care from an inpatient to an outpatient setting. J
Gen Intern Med. 2003;18:646-651.
[3] Forster AJ, Clark HD, Menard A, et al. Adverse events among medical patients after discharge from hospital.
CMAJ. 2004;170:345-349.
[4] Forster AJ et al., The incidence and severity of adverse events affecting patients after discharge from the hospital.
Ann Intern Med. 2003;138:161-167.
[5] Forster AJ, et al., Adverse drug events occurring following hospital discharge. J Gen Intern Med. 2005;20:317-323
[6] Vukmir RB. Kremen R. Ellis GL, et al. Compliance with emergency department referral: the effect of
computerized discharge instructions. Ann Emerg Med. 1993; 22:819-23.
[7] Jolly BT, Scott JL, Feied CF, et al. Functional illiteracy among emergency department patients: a preliminary
study. Ann Emerg Med. 1993; 22:573-8
[8] Clark PA et al., Patient perceptions of quality in discharge instruction, Patient Education and Counseling 59 (2005) 56–68
[9] DiMatteo MR. Variations in patients’ adherence to medical recommendations: a quantitative review
of 50 years of research. Med Care 2004;42:200–209.
[10] Simpson M et al., Doctor-patient communication: the Toronto consensus statement, BMJ7 1991;303:1385-7
[11] Benigeri M, Pluye P., Shortcomings of health information on the Internet, Health Promotion International
Vol. 18. No. 4, 2003
[12] Chugh A et al., Better Transitions: Improving Comprehension of Discharge Instructions, Frontiers of Health
Services Management, 2009 Spring;25(3):11-32.
[13] Krohn DA, Discharge Instructions in the Outpatient Setting: Nursing Considerations, J Radiol Nurs 2008;27:29-33.
[14] Delp C, Jones J, Communicating Information to Patients: The Use of Cartoon Illustrations to Improve
Comprehension of Instructions, Academic Emergency Medicine Mar 1996 Vol 3/No 3
[15] Austin PE, Discharge Instructions: Do Illustrations Help Our Patients Understand Them?, Annals of Emergency Medicine , March 1995,
25:3.
[16] Showalter JW, Effect of Standardized Electronic Discharge Instructions on Post-Discharge Hospital Utilization.
J Gen Intern Med 26(7):718–23 (2011)
[17] Engel GJ, The Biopsychosocial Model and the Education of Health Professionals, Ann N Y Acad Sci. 1978 Jun 21;310:169-87.
[18] Guerrero JM, Ramos P, Introduction to the Applications of Mind Mapping in Medicine, International Medical Publishing, 2015.

Introduction to the Applications of Mind Mapping in Medicine

Introducción a la Técnica de Mapas Mentales
Gestión Visual de Información Compleja con
MindManager 16
http://www.editorialuoc.cat/introduccion-a-la-tecnica-de-mapas-mentales

José M. Guerrero
jm@infoseg.com
http://www.infoseg.com/imi.shtml
https://es.linkedin.com/in/josemguerrero2012
http://www.slideshare.net/jmgf2009/presentations
https://twitter.com/InfosegS
http://paper.li/InfosegS/1356259200

Hospital Discharge Instructions using Mind Mapping

More Related Content

Viewers also liked

Similar to Hospital Discharge Instructions using Mind Mapping

More from José M. Guerrero

Recently uploaded

Hospital Discharge Instructions using Mind Mapping