Health Literacy Initiative Improves Discharge Education

ALISO VIEJO, Calif. - April 2, 2026 – Assessing health literacy levels soon after hospital admission and adjusting discharge instructions accordingly helped reduce readmission rates for pediatric patients after heart surgery and improve caregiver satisfaction scores at a California children’s hospital, according to a study in Critical Care Nurse (CCN).

“Out-the-Door, Dinosaur: Assessing Health Literacy to Improve Discharge Education” details a nurse-led initiative in the pediatric cardiothoracic intensive care unit (CTICU) at Loma Linda University Children’s Hospital that led to a more customized approach to discharge education tailored to caregivers’ health literacy levels. Among the results, the 30-day readmission rate following cardiac surgical repair decreased from 12.3% in 2022 to 10.5% in 2023.

The hospital’s CTICU is an admission-to-discharge unit with 33 licensed beds. Patients in the unit are often having congenital heart surgery for biventricular and single-ventricle repairs. To reduce the risk for readmission, their recovery requires close adherence to post-discharge care instructions.

Jennifer Newcombe, DNP, MSN, CNS-BC, CPNP-PC, AC, is co-author of the article and a pediatric cardiothoracic nurse practitioner at the hospital.

“This initiative empowered bedside nurses to deliver equitable, patient- and family-centered care, meeting family caregivers where they are and providing education in a way they can easily understand,” she said. “Families are already anxious about caring for a child at home after heart surgery, and customizing discharge education based on health literacy levels can provide them additional confidence and comfort.”

As part of the initiative, nurses began using the Newest Vital Sign to quickly assess caregivers’ health literacy levels within 24 hours of a child’s hospital admission. The validated, interviewer-administered health literacy assessment requires less than three minutes to conduct and is available in English and Spanish. A staff resource binder was created with the Newest Vital Sign tool in both languages, a script for administering the tool and a tip sheet for documenting results in the electronic health record.

During project implementation from Jan. 1, 2023, to Jan. 1, 2024, a total of 150 caregivers were screened for health literacy. While 64% of caregivers demonstrated adequate literacy, more than a third displayed limited literacy (fourth- to sixth-grade reading level) or low literacy, with a reading level below fourth grade.

To supplement the hospital’s existing online materials for patient and caregiver education, the team developed an educational toolkit with specific information related to pediatric open-heart surgery and recovery. The tiered toolkit contained educational materials designed for people with different levels of health literacy.

Prior to a patient’s discharge, a nurse would review the educational materials and care instructions with the caregiver at the identified literacy level, using the teach-back method to confirm understanding. Discharge education focused on five key areas: medication administration, wound care, cardiopulmonary resuscitation (CPR), nutrition and when additional medical care may be needed.

Caregivers also received a take-home packet of educational materials at discharge that incorporated pictures and drawings to emphasize important concepts.

Scores from an anonymous, voluntary telephone survey one week after hospital discharge rose from 80% in the first quarter of 2023 to 100% in the fourth quarter of 2023 for the question, “During this hospital stay, how often did your child’s nurses explain things to you in a way that was easy to understand?”

Evaluation also included post-discharge surveys (n=92) administered to caregivers during follow-up visits in the cardiothoracic clinic. All respondents said they felt confident in performing required medical care tasks after the patient’s discharge, and 93% thought nurses explained procedures, medications and care protocols in a way that was easy to understand.

The initiative was undertaken as part of the nurses’ participation in a yearlong, hospital-based nurse leadership and innovation program offered by the American Association of Critical-Care Nurses (AACN).

AACN Clinical Scene Investigator (CSI) Academy is a team-oriented program that builds additional skills for direct care nurses and leverages their expertise, preparing and supporting them as clinician leaders who effect positive changes that improve patient, nurse and hospital outcomes. AACN provided the program free of charge to Loma Linda University Children’s Hospital and six other hospitals in Southern California, thanks to a $100,000 grant from Edwards Lifesciences Foundation as part of the foundation’s philanthropic initiative Every Heartbeat Matters. To learn more about participating in AACN CSI Academy, complete the request form on the CSI Academy webpage.

As AACN’s bimonthly clinical practice journal for acute and critical care nurses, CCN is a trusted source of information related to the bedside care of critically and acutely ill patients. Access the article abstract and full-text PDF by visiting the CCN website at http://ccn.aacnjournals.org.

About Critical Care Nurse: Critical Care Nurse (CCN) a bimonthly clinical practice journal published by the American Association of Critical-Care Nurses, provides current, relevant and useful information about the bedside care of critically and acutely ill patients. The award-winning journal also offers columns on traditional and emerging issues across the spectrum of critical care, keeping critical care nurses informed on topics that affect their practice in acute, progressive and critical care settings. CCN enjoys a circulation of more than 134,000 and can be accessed at https://ccn.aacnjournals.org.

About the American Association of Critical-Care Nurses: For more than 55 years, the American Association of Critical-Care Nurses (AACN) has been dedicated to acute and critical care nursing excellence. The organization’s vision is to create a healthcare system driven by the needs of patients and their families in which acute and critical care nurses make their optimal contribution. AACN is the world’s largest specialty nursing organization, with more than 134,000 members and over 170 chapters in the United States.

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