Discharge instructions are hard to read: study

Epic discharge instructions remain exclusively available in English and Spanish and often surpass the recommended reading levels for patients, reports a study.

"Given the impact of readability on patient outcomes, discharge documents should be improved to enhance patient comprehension and adherence,” the authors said.

Standard documents across 1,511 discharge instructions were available in 15 languages. For standard documents in English, 81 percent exceeded the American Medical Association’s sixth-grade threshold on Flesch-Kincaid Grade Level (p<0.05) and 100 percent on Simple Measure of Gobbledygook (p<0.05).

For standard Spanish documents, none (0 percent) were above the threshold on Fernandez-Huerta (p=1.00), while 100 percent were on adjusted Simple Measure of Gobbledygook (p<0.05). The easy-to-read versions had significantly lower grade levels compared with the standard documents (p<0.05).

In regression analyses, no significant changes were observed in the grade level of discharge documents by revision month (p>0.05).

In this study, the authors extracted Epic discharge documents on adult medical conditions in English and Spanish in December 2024, along with easy-to-read versions, when available. They assessed the readability of these documents using two scoring systems for each language.

Additionally, right-sided and paired t-tests were used to analyse comparisons with the recommended grade levels and between document versions. Linear regressions were also used to assess trends in grade levels by the month of revision.

“Inadequate health literacy is linked to worse health outcomes, including higher readmission rates and adverse events,” the authors said. “Despite recommendations to keep patient materials at or below a sixth-grade reading level, many discharge instructions exceed this threshold.”