Health literacy initiative at LLU Children’s Hospital improves discharge education, reduces readmissions

A nurse-led health literacy project in the pediatric cardiothoracic intensive care unit (CTICU) at Loma Linda University Children's Hospital (LLUCH) has helped reduce 30-day readmission rates for children recovering from heart surgery and improved caregiver satisfaction with discharge education, according to a study published in Critical Care Nurse.

The initiative, detailed in the article "Out-the-Door, Dinosaur: Assessing Health Literacy to Improve Discharge Education," outlines how LLUCH nurses implemented early screening of caregivers' health literacy and tailored discharge instructions based on those results. Following the program's launch, the unit's 30-day readmission rate after surgical repair declined from 12.3% in 2022 to 10.5% in 2023.

The CTICU includes 33 licensed beds and cares for patients undergoing congenital heart surgery, including biventricular and single-ventricle repairs. Because recovery at home requires careful adherence to care instructions, clinicians sought a way to ensure information was delivered in a way families could easily understand.

"This initiative empowered bedside nurses to deliver equitable, patient- and family-centered care," said co-author Jennifer Newcombe, DNP, MSN, CNS-BC, CPNP-PC, AC, a pediatric cardiothoracic nurse practitioner at LLUCH. "Families are already anxious about caring for a child at home after heart surgery, and customizing discharge education based on literacy levels can give them confidence and comfort."

As part of the project, nurses began using the Newest Vital Sign, a validated health literacy assessment available in English and Spanish, within 24 hours of a patient's admission. The tool takes less than three minutes to complete. Nurses were provided with a resource binder containing assessment materials, scripts, and documentation guidance.

Between Jan. 1, 2023, and Jan. 1, 2024, a total of 150 caregivers were screened. Sixty-four percent demonstrated adequate literacy, while more than one-third had limited or low literacy levels.

To support understanding across all literacy levels, the team developed a tiered educational toolkit focused on pediatric open-heart surgery and postoperative care. Nurses reviewed materials with caregivers at the appropriate literacy tier before discharge, using the teach-back method to confirm understanding. Education emphasized five key areas: medication administration, wound care, CPR, nutrition, and recognizing when to seek medical attention. Caregivers also received a take-home packet with illustrations and simplified explanations.

Caregiver experience scores also improved. Responses to an anonymous phone survey conducted one week after discharge showed an increase in positive ratings, from 80% in the first quarter of 2023 to 100% in the fourth quarter, 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?" In follow-up clinic surveys, all participating caregivers reported confidence in performing required care tasks at home.

The initiative was part of the nurses' participation in the American Association of Critical-Care Nurses (AACN) Clinical Scene Investigator (CSI) Academy, a yearlong leadership and innovation program for direct-care nurses. The academy is funded through a grant from the Edwards Lifesciences Foundation as part of its Every Heartbeat Matters initiative.