User-centered design of discharge warnings tool for colorectal surgery patients.
OBJECTIVE
Readmission following colorectal surgery, typically due to surgery-related complications, is common. Patient-centered discharge warnings may guide recognition of early complication signs after colorectal surgery.


METHODS
User-centered design of a discharge warnings tool consisted of iterative health literacy review and a heuristic evaluation with human factors and clinical experts as well as patient end users to establish content validity and usability.


RESULTS
Literacy evaluation of the prototype suggested >12th-grade reading level. Subsequent revisions reduced reading level to 8th grade or below. Contents were formatted during heuristic evaluation into 3 action-oriented zones (green, yellow, and red) with relevant warning lexicons. Usability testing demonstrated comprehension of this 3-level lexicon and recognition of appropriate patient actions to take for each level.


CONCLUSIONS
We developed a discharge warnings tool for colorectal surgery using staged user-centered design. The lexicon of surgical discharge warnings could structure communication among patients, caregivers, and clinicians to improve post-discharge care.
Center for Innovations in Quality, Effectiveness, and Safety (IQuESt); Michael E. DeBakey VA Medical Center, Houston, TX, USA.|Department of Medicine, Baylor College of Medicine, Houston, TX, USA.|VA Quality Scholars Coordinating Center, Michael E. DeBakey VA Medical Center.
Aanand D
AD
Naik
Center for Innovations in Quality, Effectiveness, and Safety (IQuESt); Michael E. DeBakey VA Medical Center, Houston, TX, USA.|Department of Medicine, Baylor College of Medicine, Houston, TX, USA.|VA Quality Scholars Coordinating Center, Michael E. DeBakey VA Medical Center.
Molly J
MJ
Horstman
Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.|Department of Medicine, Boston University School of Medicine, Boston, MA, USA.
Linda T
LT
Li
Jesse H. Jones Graduate School of Business, Rice University, Houston, TX, USA.
Michael K
MK
Paasche-Orlow
Center for Innovations in Quality, Effectiveness, and Safety (IQuESt); Michael E. DeBakey VA Medical Center, Houston, TX, USA.
Bryan
B
Campbell
Center for Innovations in Quality, Effectiveness, and Safety (IQuESt); Michael E. DeBakey VA Medical Center, Houston, TX, USA.|Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
Whitney L
WL
Mills
Center for Innovations in Quality, Effectiveness, and Safety (IQuESt); Michael E. DeBakey VA Medical Center, Houston, TX, USA.|Department of Gastrointestinal Oncology, Section of Hepatobiliary Tumors and Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
Levi I
LI
Herman
Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.|Department of General Surgery, Columbia University College of Physicians and Surgeons, New York, NY, USA.
Daniel A
DA
Anaya
Center for Innovations in Quality, Effectiveness, and Safety (IQuESt); Michael E. DeBakey VA Medical Center, Houston, TX, USA.|Department of Medicine, Baylor College of Medicine, Houston, TX, USA.|Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
Barbara W
BW
Trautner
Center for Innovations in Quality, Effectiveness, and Safety (IQuESt); Michael E. DeBakey VA Medical Center, Houston, TX, USA.|Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
David H
DH
Berger
D001296:Audiovisual Aids; D003082:Colectomy; D003107:Colorectal Surgery; D003125:Colostomy; D013505:Digestive System Surgical Procedures; D057220:Health Literacy; D006801:Humans; D010351:Patient Discharge; D010353:Patient Education as Topic; D010359:Patient Readmission
colorectal surgery; discharge instructions; health literacy; readmissions; usability testing