Patient Directed Discharge Letter (PADDLE): A novel approach to improve patient knowledge, satisfaction and outcomes

INTERVENTION: Participants will be randomised (1:1) to a standard hospital discharge letter or both a standard hospital discharge letter AND a patient directed discharge letter (PADDLE) tailored to their individual situation and explained to them face to face by their physician. Standard hospital discharge letters are written to the patient's GP. This letter describes the patient's hospital presentation, diagnosis, treatments and recommendations. The letter includes details of investigations and results, and is written using medical terminology for the doctor. All patients receive this standard letter at discharge. The patient directed discharge letter (PADDLE) is written using lay person's language and focuses on 4 headings: reasons the patient came into hospital, important tests and results, treatment received, and recommendations for when the patient goes home. Information is tailored to each patient's care and includes recommendations for follow up after discharge eg lifestyle changes, further testing, further contact with Health Professionals. Completing this PADDLE letter will take approximately 5 minutes. The PADDLE letter is written and explained to the patient at the bedside by their treating doctor. This explanation will take approximately 10‐15 minutes. CONDITION: acute coronary syndrome ;pneumonia ;Type I diabetes ;atrial fibrilllation;heart failure;Chronic obstructive pulmonary disease;Pulmonary embolism;pyelonephritis;cellulitis;Hyponatraemia;Type II diabetes;treatment for thyroid cancer; ; acute coronary syndrome; ; ; pneumonia; ; Type I diabetes; ; ; atrial fibrilllation ; heart failure ; Chronic obstructive pulmonary disease ; Pulmonary embolism ; pyelonephritis ; cellulitis ; Hyponatraemia ; Type II diabetes ; treatment for thyroid cancer Cardiovascular ‐ Other cardiovascular diseases Metabolic and Endocrine ‐ Other endocrine disorders Public Health ‐ Health promotion/education Respiratory ‐ Other respiratory disorders / diseases PRIMARY OUTCOME: Adherence to post‐discharge recommendations [Adherence to post‐discharge recommendations will be assessed 1 week post‐discharge by study‐specific questionnaires. We have 92% power to detect a 30% difference in adherence using a Likert scale (1‐5) (average 4.3 versus 3.0 [SD 3.0]) with our proposed sample size (120 PADDLE versus 120 Control subjects). ; ; ; ] Knowledge:; Global knowledge score, calculated as a sum of scores of the 4 domains; 1. reasons for admission and diagnosis, 2. tests performed, 3. treatments received and 4. follow up plan and recommendations. This is a composite outcome.; [Participant's knowledge of the 4 domains will be will be assessed at week 1 follow up telephone call assessed by a study‐specific questionnaire.] Satisfaction:; Satisfaction with hospital care and preparedness for discharge as assessed by study specific questionnaire. This is a composite outcome.[Participant's level of satisfaction will be assessed 1 week post‐discharge using a study‐specific questionnaire.] SECONDARY OUTCOME: Adherence to post‐discharge recommendations ; [Adherence will be assessed using study specific questionnaires 1 week post‐discharge using participant's self‐report. Point score expressed as percentage will be calculated based on participant responses 1 week post‐discharge compared with discharge summary. ; ] Knowledge: ; A secondary knowledge endpoint is the individual score for domain; 1: . reasons for admission and diagnosis. This will be assessed by a study‐specific questionnaire.. ; ; [Participant's knowledge of the reasons for admission and diagnosis will be assessed 1 week post‐discharge by a study‐specific questionnaire.] Knowledge: ; A secondary knowledge endpoint is the individual score for domain; 2: . tests performed . This will be assessed by a study‐specific questionnaire.. ; A secondary knowledge endpoint is the individual score for domain 4: follow‐up plan and recommendations . This will be assessed by a study‐specific questionnaire.. [Participant's knowledge of the follow‐up plan and recommendations will be assessed 1 week post‐discharge by a study‐specific questionnaire.] Knowledge: ; ; [Participant's knowledge of tests performed will be assessed 1 week post‐discharge by a study‐specific questionnaire.] Knowledge: ; A secondary knowledge endpoint is the individual score for domain; 3: treatments received. This will be assessed by a study‐specific questionnaire.. ; [Participant's knowledge of treatments received will be assessed 1 week post‐discharge by a study‐specific questionnaire.] Re‐hospitalisations[Re‐hospitalisations will be assessed at 1 week and 6 months post‐discharge using study specific questionnaires and confirmed by Medicare data linkage. Medical Benefits Schedule and Pharmaceutical Benefits Scheme claims usage through Medicare Australia will be collected to ascertain use of medical services and prescribed pharmaceuticals. ; Note: Re‐hospitalisation is listed as a secondary outcome, because the ANZCTR site allows only 3 primary outcomes. We will use re‐hospitalisation at 6 months post‐discharge as a primary outcome measure. Re‐hospitalisation at 1 week and Pharmaceutical Benefits Claim usage will be secondary endpoints. ] Satisfaction: ; Satisfaction with hospital care and preparedness for discharge as assessed by study specific questionnaire. This is a composite outcome.[Satisfaction with hospital care and preparedness for discharge ‐ at discharge using a study‐specific questionnaire. ; Participants receiving a PADDLE letter will be assessed at discharge using additional study specific questionnaires to determine satisfaction with the PADDLE letter. ; Utilisation of the PADDLE letter will be assessed at 1 week post‐discharge. ; ] INCLUSION CRITERIA: Participants are eligible for the study if the current hospital admission is due to: 1. Admitted to hospital with one of the following as a primary diagnosis a. A cardiac diagnosis of acute coronary syndrome (ACS), or heart failure (HF), or atrial fibrillation (AF) b. A respiratory diagnosis of pneumonia, or pulmonary embolus (PE), or chronic obstructive pulmonary disease (COPD) c. A general medicine diagnosis of pneumonia, or pyelonephritis, or cellulitis d. An endocrine diagnosis of Type I diabetes, or Type II diabetes, or treatment for thyroid cancer or hyponatraemia 2. Age greater than or equal to 18 years of age 3. Able to provide written informed consent