From Clinic to Recovery · First Edition
Chapter 03 — Printed and Digital Patient Education: Closing the Gap Between Clinic and Home
Dr. Tamer Rushdy Elalfy · 8 min read
In this chapter
Patients leave the clinic with an explanation that was given quickly, under stress, and often to someone who is frightened. Reinforcing that explanation in writing, giving patients a reliable way to look things up at home, and making sure that someone answers when they call, are among the simplest ways to improve safety and satisfaction after surgery.
Learning objectives After reading this chapter you should be able to:
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3.1 Why patients forget
A review of the literature on memory for medical information found that between 40% and 80% of the information given by healthcare professionals is forgotten immediately, that the more information is given the smaller the proportion recalled, and that almost half of what is remembered is incorrect [24]. Anxiety, pain, unfamiliar vocabulary, and the distraction of other family members all make this worse. Recall improves when the most important instructions are given first, when information is grouped under clear headings, and when spoken advice is supported by written or visual material [24].
This does not mean that clinicians should say less. It means that the most important messages should be few, repeated, and supported in writing.
3.2 Health literacy and reading level
Health literacy is the ability to find, understand, and use health information to make decisions. It is limited in a substantial proportion of adults, including highly educated adults who are unfamiliar with medical language, and it falls further under stress [25]. The usual recommendation for patient materials is a reading level of about sixth grade (age 11 to 12). Readability tools in word processors give an estimate, but they are less reliable in languages other than English, including Arabic. The best test is to ask someone outside medicine to read the handout and explain it back.
Writing at this level is not talking down to the reader. It means short sentences, common words, and one idea per paragraph.
3.3 Principles for printed materials
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Put the most important instruction first, and state what the patient should do, not only what to avoid.
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Use headings that are questions patients actually ask, such as “When can I shower?”
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Use short sentences, active voice, and common words. Define any medical term the first time it appears.
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Use numbers and times, not vague words: “call us if your temperature is above 38 °C,” not “if you have a high fever.”
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Use a clear font of at least 12 points, generous spacing, and simple drawings where they help.
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Use the same layout for every operation, so that patients and staff learn where to find information.
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Include the date of the last review, the name of the unit, and a phone number that is answered.
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Separate expected symptoms from warning signs, using the green, amber, and red system described in this book.
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Test the handout with teach-back on a few patients before using it widely.
3.4 Choosing the channel
Each channel has strengths and limits (Table 3.1). Most patients need more than one.
Table 3.1. Choosing the channel for patient information.
| Channel | Best used for | Limits |
|---|---|---|
| Spoken, with teach-back | Building trust, explaining why, checking understanding, answering questions | Quickly forgotten; depends on the clinician’s time |
| Printed guide | Step-by-step instructions; the personal instruction card; warning-sign lists | Can be lost; static; one language per version |
| QR code to a web page | Longer explanations, pictures or video, several languages, updates | Requires a smartphone and data; content must be checked for accuracy and currency |
| Telephone or message follow-up | Early recovery questions, reassurance, spotting problems early | Needs staff time and a clear process for escalation (Section 3.7) |
A QR code is an effective bridge from the printed page to online material. It does not replace a printed list of warning signs and a phone number, which the patient must be able to find even without a phone signal.
3.5 Evaluating digital resources
Online health information varies widely in quality. Before recommending a website or app to patients, or placing a link in a handout, check it against the questions in Table 3.2.
Table 3.2. A checklist for evaluating digital patient education resources.
| Question | What to look for |
|---|---|
| Who wrote it? | Named authors with clinical credentials, and an identified organization |
| When was it reviewed? | A visible date, and evidence that it is revised when guidelines change |
| What is it based on? | References to guidelines or published evidence |
| Are there conflicts of interest? | A clear statement of funding, sponsorship, and commercial links |
| Is it consistent with our protocols? | Fasting, medicine advice, and timelines match your unit’s practice, or are clearly labeled as general guidance |
| Is it safe for patients? | No advertising of treatments, no personal data collected without consent, and clear privacy terms |
| Can everyone use it? | Works on a basic smartphone, is readable at a low reading level, and is available in the languages your patients speak, including right-to-left layouts for Arabic |
Translations should be produced or reviewed by a qualified translator who understands medical terminology, and checked by a clinician who speaks the target language. Machine translation without review risks errors in doses, timings, and warning signs.
Digital platforms, including the AlfiSurgery platform founded by the author (see the disclosure at the start of this book), are examples of this approach and should be assessed with the same checklist as any other resource.
3.6 The clinic-to-home information package
Every patient should leave the clinic or the ward with the same core package, whether it is on paper, on a phone, or both. Figure 3.1 shows how the pieces connect.
[Figure — diagram omitted in this text edition; see the figure caption below and the Word chapter file for the image]
Figure 3.1. The clinic-to-home information loop.
Core package for every surgical patient
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3.7 Answering questions after discharge
Most questions after an operation arise at home, often in the evening or at night, when the clinic is closed. A patient who cannot get an answer may ignore a warning sign, or may go to the emergency department with a symptom that was expected. A planned contact point, staffed by people who use the same warning-sign system as the printed guide, prevents both.
Figure 3.2 shows a simple structure for a nurse-led telephone or message contact. The caller’s symptoms are matched to the green, amber, and red signs in the patient guide, red signs are asked about first, and every call ends with a clear plan.
[Figure — diagram omitted in this text edition; see the figure caption below and the Word chapter file for the image]
Figure 3.2. Telephone follow-up using the green, amber, and red warning signs.
Script: telephone follow-up (for nurses)
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3.8 Closing the loop
The loop closes at follow-up. Ask patients what was confusing, what they could not find, and what they wish they had been told. Review the questions received by telephone as well, because a question that keeps coming back shows a gap in the handout. Use these answers to revise the materials, and record the date of each revision. A handout that has not changed since its first version has probably stopped being checked.
Key points
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