title: Readability of discharge summaries: with what level of information are we dismissing our patients?
abstract: BACKGROUND
  We assessed the health literacy of trauma discharge summaries and hypothesize that they are written at higher-than-recommended grade levels.
  
  
  METHODS
  The Flesch-Kincaid grade level (FKGL) and Flesch reading ease scores (FRES), 2 universally accepted scales for evaluating readability of medical information, were used.
  
  
  RESULTS
  A total of 497 patients were included. The mean patient age was 56 ± 22 years. Average FKGL and FRES were 10 ± 1 and 44 ± 7, including 132 summaries classified as very or fairly difficult to read. A total of 204 (65%) patients had functional reading skills at grade levels below the FKGL of their dismissal note; only 74 patients (24%) had the reading skills to adequately comprehend their dismissal summary. Total 30-day readmissions were 40, 65% of whom were patients with inadequate literacy for dismissal summary comprehension.
  
  
  CONCLUSIONS
  Patient discharge notes are written at too advanced of an educational level. To ensure patient comprehension, dismissal notes should be rewritten to a 6th-grade level.
authors.affiliation: Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
authors.forename: Asad J
authors.initials: AJ
authors.lastname: Choudhry
authors.affiliation: Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
authors.forename: Yaser M K
authors.initials: YM
authors.lastname: Baghdadi
authors.affiliation: Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Surgical Outcomes Program, Mayo Clinic, Rochester, MN, USA.
authors.forename: Amy E
authors.initials: AE
authors.lastname: Wagie
authors.affiliation: Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Surgical Outcomes Program, Mayo Clinic, Rochester, MN, USA.
authors.forename: Elizabeth B
authors.initials: EB
authors.lastname: Habermann
authors.affiliation: Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
authors.forename: Stephanie F
authors.initials: SF
authors.lastname: Heller
authors.affiliation: Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
authors.forename: Donald H
authors.initials: DH
authors.lastname: Jenkins
authors.affiliation: Department of Surgery, Marshfield Clinic, Marshfield, WI, USA.
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Cullinane
authors.affiliation: Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. Electronic address: zielinski.martin@mayo.edu.
authors.forename: Martin D
authors.initials: MD
authors.lastname: Zielinski
mesh_terms: D000328:Adult; D003710:Demography; D004522:Educational Status; D005260:Female; D057220:Health Literacy; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D063886:Patient Discharge Summaries; D010359:Patient Readmission / Q000706:statistics & numerical data; D011932:Reading; D012042:Registries; D012189:Retrospective Studies; D014947:Wounds and Injuries / Q000601:surgery*
keywords: Educational disparities; Flesch–Kincaid grade level; Health literacy; Readability; Trauma readmissions