YEKATIT 12 HOSPITAL MEDICAL COLEGE

HEALTH LITRACY DEPARTMENT

QI Project on improving patient understanding of

discharge instructions in surgical ward by October,
2025G.C
 QUALITY IMPROVEMENT PROJECT

Project: Improving patient understanding of discharge instructions in surgical ward

Sponsor: Yekatit 12 HMC SMT and Surgical department Head
Project Start Date: July 6, 2025G.C
Last Revised: October 6, 2025G.C
List QI Team

S. No. QI Team Position Role

1 BONSA ADUGNA GELETA Quality officer QI Team
2 NAOL ALULA HLU case team QI Team
3 SIMACHEW ZERIHUN HLU staff QI team
4 TIRUYE HLU staff QI team

List of participants
1. Solomon Dagnre Nurse, SB case team QI members
2. Haymanot. Nurse,SA case team QI members
3. Biyaba Nurse QI members
4. Semira Hadra Nurse QI members
5. Melkamu Nurse QI members

List of Problems observed Yekatit 12 HMC IPD on health literacy and

Prioritization Matrix
List of problems Frequ Urgen Feasibility Impact Availability of Total
ency cy resources score

Preoperative instruction of admitted 4 5 3 5 3 20

pt.
Patient understanding of discharge 5 5 4 5 4 23
instructions in surgical ward
Preoperative hospital stay 5 5 3 5 4 22

Informed consent understanding 3 5 3 5 3 19

 What we try to accomplish?
Problem
For the past 3 months the percentage of patients who could understand instructions on their
treatment after being discharged from the hospital were 50% This might be lead to poor
treatment adherence ,increased complications and avoidable re admissions.

60%

50% 52%
50% 50% 50%

40% 40%

30% post discharge understanding

Median
20%

10%

0%
april may June

Baseline Data on Post Discharge Understanding

Description

We will seek to improve the percentage of patients understanding after discharge

Rationales

 People who were discharged without understanding their treatment and post discharge
instruction were poorly adhere to their medications, develop complications and re-admitted
to wards.

Expected Outcomes

 In successful complication of this project we will improve patients understanding on

instructions during their discharge. We hope there will be increased patients
understanding after discharge
Aim Statement

 We Y12HMC health literacy unit and Surgical Ward department plan to increase patient
understanding after discharge from current 50% to 80% from June, 2025G.C –October,
2025G.C at Y12HMC

Outcome measure

 Percentage of patients readmitted within 30 days of discharge due to complications or non-

compliance.

Process measures

 Number of educational sessions held for patients about discharge plans.

 Number of education materials (Leaflet/brochures) given

 Number of discharge summary translated

Balancing measure

 Staff workload
How will we know that change is an improvement?

We will know if the change is an improvement if the percentage of patient who understand post
discharge instruction in surgical ward increases from the current 50 % toward the target of 80%
within three months, indicating more post discharge health education and decreasing the number
of patients who readmitted after discharge demonstrating timely linkage to the instruction
delivery after discharge. Consistent, accurate data collection and sustained decrease in
readmission will confirm that the implemented changes are leading to real improvements in
increased understanding post discharge instruction.
 ROOT CAUSE ANALYSIS

People Environment
Language barriers
&Inconsistent health
education Disturbing Noise
listen Over the past 3 months
understanding of the
patients after discharge
were 50%
Lack of
Lack of adherence to
brochures/leaflets discharge
on discharge
Materials Equipment
Metho
ds
Figure 1:-Fishbone diagram
OUTCOME PRIMARY DRIVER SECONDARY CHANGE IDEA
DRIVER

Language Give instruction

We Y12HMC People barrier with translator
health literacy unit
and Surgical Ward Noise
Environm environment Availing separate
department plan to
ent counseling area
increase patient
understanding Lack of protocol Protocol
Method adherence monitoring and
after discharge
adherence
from current 50%
to 80% from June, Inadequate Preparing
Materials brochures/leaflets leaflet/education
2025G.C –October,
materials
2025G.C at
Y12HMC

Figure 2:-Driver diagram/Reverse fishbone

INITIAL ACTIVITIES

AIM STATEMENT

 To increase patients understanding after discharge from 50% to 80% by the end of October,
2025G.C

Indicator

 % patients who understand well post discharge

Denominator

 % of total patients who discharged from the ward

Data source

 EMR & Register

Process measure

 Indicator: percentage of pt. discharge summary with translator

Numerator: No. of pts. With translated discharge summary

Denominator: Total no of translation requiring pts. discharged from ward

 Indicator: percentage of pt who took leaflets/brochures

Numerator: #of patient who took leaflet/brochures

Denominator: #Total no. of patients discharged from surgical ward

 Indicator: Number of educational sessions held for patients about discharge plan
 What changes can we make that will result in improvement?
Initial Activities
 Explore and analyze the discharge process using interviews, observations, and process
mapping.
 Collect baseline data on discharge instructions and post discharge re-admission
 Identify gaps and bottlenecks in discharge process
 Develop or adapt standardized discharge tools and checklists.
 Plan and conduct health education sessions

Prioritization matrix for implementation of change ideas

Change ideas Rank criteria (1-3) Total Rank
Trialability Simplicity observability Compatibility
Give instruction with translator 3 2 3 3 11 1st

Protocol monitoring and 3 2 2 2 9 3rd

adherence
Availing separate counseling 2 2 3 2 9 3rd
area
Preparing leaflet/education 3 2 3 2 10 2nd
materials

PDSA CYCLE
Change I (Give instruction with translator)
Plan:
 What: Improve patients understanding post discharge using translator
 Where: Y12HMC surgical ward
 When: During each translation requiring patients discharge. (June, 2025 to October 2025).
 Who: Surgical Ward(A &B)
 How: by using translator during during instruction
 Prediction: This change idea will increase understanding of instruction post discharge from
50% to 65%

Change II (Brochures/leaflets )
Plan:
 What: availing discharge education materials like brochures/leaflets entailing discharge
instruction
 Where: Y12HMC surgical ward
 When: every patients discharged from surgical patients
 Who: Health literacy unit case team leader
 How: review the discharge summary monitoring checklist
 Prediction: This change idea will increase post discharge understanding from 65% to 70%

Change III (protocol monitoring)

Plan:
 What: avail protocol monitoring for the adherence.
 Where: Y12HMC surgical ward
 When: Weekly (July, 2025)
 Who : Health literacy unit staff
 How: direct interview and review the register
 Prediction: This change idea will increase post discharge instruction understanding from 70%
to 75%

Change IV (separate counseling area )

Plan:
 What: counseling at separate area/room
 Where: Y12HMC surgical ward
 When: Bi-weekly (every other weekly forum session)
 Who: QI Team and surgical ward coordinators
 How: preparing separate noise free area for discharge instruction counseling
  Prediction: This change idea will increase post discharge instruction understanding from 75%
to 80%

Run Chart after Implementation Of Change Ideas

25% Separate counseling

area
post discharge understanding
Median
20% 20% 20%
Instruction with 19% 19% 19% 19%
translator 18% 18% 18%
17%
16% 16% 16%
15% 15% 15%
14%
13% 13% 13% 13% 13% 13% 13% 13% 13% 13% 13% 13% 13% 13% 13% 13%

10%

5%

0%
W-1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4
 Key Stakeholders
 Surgical ward teams – frontline staff who conducts instruction for patient during discharge.
 Hospital Management and Leadership – provide support, resources, and oversight.
 Health literacy unit case team leader and staff members
 Quality Improvement (QI) Team – coordinates the project, monitor data, and drive
improvements.

Major Boundaries
 The project focuses only on post discharge instruction and re-admission among surgical
patients discharged at Y12HMC surgical ward.
 The project duration is limited to three months (July 21 to October 20, 2025).
 The project uses existing staff and resources; no additional funding or major equipment
purchases are planned.
 Patient data must be handled according to hospital privacy policies and national regulations.
Challenges & Solutions:

Sustainability Plan:

o Integrate templates into EMR or printed charts

o Monthly refresher for nurses and new staff

o Include in orientation for new educators

o Quarterly audit and feedback report

Documentation Checklist:

Before discharge, ensure:

✅ Written discharge summary (translated)

✅ Verbal education completed

✅ Teach-back performed and documented

✅ Family member involved (if needed)

✅ Brochure or leaflet given

Summary:

This QI project empowers patients and supports staff by creating a consistent, culturally
appropriate, and easy-to-use health education process. It aligns with national goals for patient
safety, chronic disease control, and reducing readmissions.