Readability of postoperative discharge instructions is associated with complication rate in companion animals undergoing sterilisation.

BACKGROUND: Readability of client communications is a commonly overlooked topic in veterinary medical education. In human medicine, it has been advised that the readability of patient materials should be at USA schooling sixth-grade level or below. We hypothesised that student written discharge instructions would be of an inappropriate readability level, and discharges scored with higher reading grade levels would be associated with more complications. METHODS: The cohort comprised 149 dogs and cats presenting for sterilisation. The readability of discharge instructions was assessed using the Flesch Reading Ease (FRE) and Flesch-Kincaid Grade Level (FKGL) formulas. Records were examined for evidence of postoperative complications. RESULTS: The mean FRE score of the discharge instructions was 61.97, with 30.87% being classified as 'difficult' or 'fairly difficult', 60.4% as 'standard' and 8.72% as 'fairly easy'. The mean FKGL was 8.64, with 98% being above reading level 6. Overall, there was an association between FKGL and complication occurrence (p = 0.005). Stratification by species demonstrated FRE and FKGL to be associated with complication occurrence in dogs (FRE score, p = 0.038; FKGL, p = 0.002), but not cats (FRE score, p = 0.964; FKGL, p = 0.679). LIMITATIONS: Due to the retrospective nature of the study, there were difficulties associated with extracting relevant complication information from the medical records. CONCLUSION: Only 2% of owner-directed discharge instructions were written at readability levels aligning with the recommendations set forth in the human guidelines.

Association of Standardized Tracheostomy Care Protocol Implementation and Reinforcement With the Prevention of Life-Threatening Respiratory Events.

IMPORTANCE: Mucus plugging after tracheostomy is a preventable cause of respiratory distress. Implementation of standardized tracheostomy care guidelines may reduce the occurrence of fatal respiratory compromise. OBJECTIVE: To determine the effect of implementing and reinforcing a standardized tracheostomy care protocol on the occurrence of acute life-threatening respiratory events. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study of adult patients who received a tracheostomy between May 2014 and August 2016 at a tertiary care center. MAIN OUTCOMES AND MEASURES: Patient demographics, tracheostomy indication, rapid response for mucus plugging and other acute events, duration of hospital stay, and levels of care that the patients received were recorded through examination of clinical logs. Statistical analysis was conducted between patients before protocol implementation and patients after protocol implementation in terms of rapid-response use, and intragroup comparison of the mean length of stay in various hospital units was also analyzed. RESULTS: A total of 247 patients (89 women [36%]; mean [SD] age, 58.5 [12.3] years), 117 preprotocol and 130 postprotocol, met inclusion criteria. Of the 130 patients in the postprotocol cohort, 123 (93%) were on the new tracheostomy care protocol. Preprotocol rapid-response rate was 21 of 117 patients (17.9%) and postprotocol response rate was 12 of 130 patients (9.2%) for a difference of 8.7% (95% CI, 0.2%-18.0%). In terms of mucus plugging, preprotocol rate was 8 of 117 patients (6.8%) and the postprotocol rate was 1 of 130 patients (0.8%) for a difference of 6.0% (95% CI, 1.3%-12.2%). Intragroup difference of the mean time spent (days) in various care units between patients in the no rapid-response group vs rapid-response group demonstrated clinically meaningful longer stay for rapid responses in both preprotocol and postprotocol groups for the intensive care unit (preprotocol, 2.03; 95% CI, 1.03-3.03 vs postprotocol, 3.02; 95% CI, 1.49-4.45) and step down units (preprotocol, 1.40; 95% CI, 0.77-2.02 vs postprotocol, 2.11; 95% CI, 0.78 to 3.44). CONCLUSIONS AND RELEVANCE: Implementation and reinforcement of a standardized tracheostomy care protocol was associated with a reduction in the occurrences of rapid-response calls for life-threatening mucus plugging and is recommended for clinical practice. In addition, length of stay in the intensive care unit and intermediate surgical care unit was increased in a clinically meaningful way for patients who experienced a rapid-response event.