Preferred Name

Michele M. Hughes

Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.


Date of Graduation

Fall 2017

Document Type


Degree Name

Doctor of Nursing Practice (DNP)


School of Nursing


Andrea Knopp

Julie T. Sanford

John Bowman


Problem: Payers of health insurance are tracking key performance measures and are limiting payments to hospitals. With this threat to financial reimbursement hospital systems have increased emphasis on tracking and improving outcomes. The purpose of this project is to reduce all-cause 30-day readmissions and improve patient satisfaction scores in the care transitions domain after a total hip or total knee replacement by revising the discharge materials and education.

Method: The total joint replacement discharge education materials were revised to address the common causes of readmissions. The documents were reformatted to improve literacy level, readability, and patient learning. Nurses were educated to address patient learning preferences, barriers, and comprehension in their discharge teaching.

Findings: Nurse pre-surveys and the implementation of the revised discharge education plan showed a statistically significant positive change in behavior in identifying learning preferences, removing barriers to learning, including family in teaching, using the teach-back method, and considering cultural appropriateness. The readmission rate dropped significantly from 8.87% to 2.92%. The patient responses in the care transition HCAHPS questions also improved.

Conclusion: Improving the readability of the discharge material and individualizing the information and delivery based on patient needs, and preferences can improve patient confidence to care for themselves after discharge and reduce hospital readmissions.

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