How to Write Patient Discharge Instructions That Prevent Readmissions in 2026

Your patient is being discharged after three days in the hospital for heart failure. You hand them a packet of discharge instructions—six pages of medical terminology, small print, and generic warnings. They nod, sign the form, and head home. Within a week, they're back in the emergency room because they stopped taking their diuretic, didn't recognize warning signs, or couldn't get their medications filled.

Hospital readmissions within 30 days cost the U.S. healthcare system $26 billion annually. Up to 75% of those readmissions are potentially preventable. The problem isn't just that patients get sicker—it's that they're sent home without understanding how to stay well.

This guide breaks down how to write discharge instructions patients actually understand and follow—the health literacy strategies, medication adherence techniques, and red flag guidance that reduces preventable readmissions and supports safe transitions home.

Why Most Discharge Instructions Fail

You've seen the standard discharge packet: photocopied pages with tiny font, medical jargon, and generic warnings that could apply to anyone. These fail for predictable reasons:

They're written at the wrong reading level. The average American reads at a 7th-8th grade level. Most discharge instructions are written at a 10th-12th grade level or higher. If patients can't understand the instructions, they can't follow them.

They're full of unexplained medical jargon. "Monitor for signs of CHF exacerbation" means nothing to most patients. "Call your doctor if you gain more than 3 pounds in one day or have trouble breathing" is actionable.

Medication instructions are unclear or incomplete. "Take as directed" isn't helpful if the patient doesn't know what "as directed" means. Did the dose change? Should they stop their old medication? What if they forget a dose?

Warning signs aren't specific enough. "Seek medical attention if symptoms worsen" leaves patients guessing. What symptoms? How much worsening? Go to ER or call doctor? Patients need clear thresholds: "Fever over 101°F, call doctor. Chest pain, call 911."

There's no verification that patients understand. You hand them instructions, they sign, they leave. No one checks if they can explain back what the instructions mean. This is why teach-back methods matter.

The Health Literacy Framework

Health literacy isn't about intelligence. It's about whether medical information is communicated in ways people can understand and act on. About 90 million Americans have low health literacy—meaning they struggle to understand prescription labels, appointment slips, or discharge instructions.

Writing at the Right Level

Target a 5th-6th grade reading level for discharge instructions. This doesn't mean dumbing down—it means clarity.

Compare:

Complex: "Ambulate short distances multiple times daily to enhance cardiovascular conditioning and prevent complications associated with prolonged immobility."

Clear: "Walk around your house or neighborhood several times each day. This helps your heart get stronger and prevents blood clots."

Both say the same thing. The second one is readable by more people.

Translating Medical Jargon

Every medical term should either be replaced with plain language or defined immediately:

• Hypertension → High blood pressure
• Myocardial infarction → Heart attack
• Exacerbation → Flare-up or worsening
• NPO → Nothing to eat or drink
• PRN → As needed
• Chronic → Long-term
• Acute → Sudden

When you must use medical terms (for medication names, for example), explain them: "Furosemide (Lasix) is a water pill that helps your body get rid of extra fluid."

Active Voice and Direct Language

Use "you" and active voice. It's more engaging and clearer.

Passive: "Medications should be taken as prescribed by your healthcare provider."

Active: "Take your medications exactly as your doctor prescribed."

The second version is shorter, clearer, and feels like it's talking to you, not about you.

Visual Design for Readability

Design matters as much as words:

• Use 14-point font minimum (12pt for headers)
• Use bullet points and numbered lists instead of paragraphs
• Leave white space—don't cram text edge to edge
• Use bold for critical information (warning signs, STOP medications)
• Use color coding if possible (red for warnings, green for approved actions)
• Include simple diagrams or icons (pills, thermometer, phone for emergency)

Think about where patients will use these instructions: likely taped to the refrigerator, not filed away. Make them scannable.

Medication Instructions That Prevent Errors

Medication errors after discharge are one of the top causes of preventable readmissions. The problem usually isn't that patients willfully ignore instructions—it's that instructions are confusing.

The Medication Reconciliation Problem

Patients get confused about which medications to take because they're not told clearly which changed:

• Medications started in the hospital (NEW)
• Medications that changed doses (CHANGED)
• Medications they should stop taking (STOP)
• Medications to continue unchanged (CONTINUE)

Your discharge instructions must clearly label each category.

Clear Medication Format

For each medication, include:

Medication name (generic and brand if both are used)
What it's for (in plain language)
How to take it (dose, route, frequency)
Special instructions (take with food, avoid alcohol, common side effects)
Status (NEW, CHANGED, STOP, CONTINUE)

Example:

Metoprolol (Lopressor) - For your heart and blood pressure
• Take 50mg by mouth twice daily (morning and evening)
• Important: Don't stop this suddenly. If you have side effects, call your doctor first.
• **CHANGED** - Your dose was increased from 25mg to 50mg in the hospital

Lisinopril - For high blood pressure
• **STOP TAKING** - This was replaced by a different blood pressure medication (metoprolol above)

Addressing the "What If" Questions

Patients have predictable questions about medications. Answer them proactively:

• What if I miss a dose? ("Take it as soon as you remember unless it's almost time for the next dose. Don't double up.")
• What if I can't afford my medications? (Include pharmacy assistance program contacts)
• Can I take this with my other pills? (Explain timing if medications interact)
• What are side effects? (List common ones and what to do)
• How long will I take this? ("Until your doctor says to stop" or "For 7 days until the antibiotic is finished")

Pill Organizers and Adherence Tools

Recommend practical adherence strategies:

"Use a weekly pill organizer to sort your medications each Sunday. This helps you see if you've taken today's dose and prevents double-dosing. Set a phone alarm for your medication times. Keep a medication list in your wallet and show it to any doctor you visit."

These simple tools dramatically improve adherence, but patients need to be told to use them.

Activity and Self-Care Instructions

"Take it easy but stay active" is too vague. Patients need specific guidance about what they can and can't do.

Activity Restrictions with Examples

Instead of "No heavy lifting," specify the weight limit and give examples:

✓ **You CAN:**

• Walk around your home and neighborhood
• Climb stairs slowly (rest if you get short of breath)
• Prepare light meals
• Shower (keep surgical wound dry with plastic wrap)

✗ **You should NOT:**

• Lift anything heavier than 10 pounds (no heavy grocery bags, laundry baskets, small children)
• Drive for 2 weeks (until cleared by your doctor)
• Exercise strenuously (no running, gym workouts, yard work)
• Return to work until your doctor clears you

Specific examples help patients know exactly what the restriction means in their daily life.

Diet Changes with Practical Guidance

"Low-sodium diet" is meaningless without specifics. What does low-sodium mean? What foods should they avoid?

Better: "Eat less than 2000mg of sodium per day:

• Avoid: canned soups, deli meat, frozen dinners, fast food, salty snacks, soy sauce
• Choose: fresh fruits and vegetables, lean meats, whole grains
• Read food labels: Look for 'low sodium' or less than 200mg per serving
• Don't add salt when cooking or at the table
• Season with herbs, lemon, garlic instead"

This gives patients actionable steps and specific foods to avoid or choose.

Wound Care with Step-by-Step Instructions

If patients have surgical wounds, dressing changes, or other care tasks, provide step-by-step instructions with pictures if possible:

"How to change your wound bandage:

1. Wash your hands with soap and water
2. Remove old bandage gently (it's okay if there's a little dried blood)
3. Gently clean wound with mild soap and water, pat dry with clean towel
4. Check for signs of infection (see Warning Signs section)
5. Apply new clean bandage
6. Wash hands again
7. Do this once daily and anytime bandage gets wet or dirty"

Breaking it into numbered steps makes it less overwhelming.

Warning Signs: The Critical Section

This is the most important part of discharge instructions. Patients need to know exactly when to seek help and what level of urgency applies.

Three Levels of Urgency

Structure warning signs by urgency level:

CALL 911 or GO TO EMERGENCY ROOM immediately if you have:

• Chest pain or pressure
• Severe shortness of breath
• Sudden weakness or numbness on one side
• Confusion or trouble speaking
• Severe bleeding that won't stop
• Loss of consciousness

CALL YOUR DOCTOR within 24 hours if you have:

• Fever over 101°F
• Weight gain of more than 3 pounds in one day
• Increased swelling in legs or feet
• Wound that's red, warm, or draining pus
• Vomiting that prevents you from taking medications
• Pain not controlled by prescribed medications

What's NORMAL during recovery:

• Feeling tired for the first week
• Decreased appetite
• Mild soreness at incision site
• Mild dizziness when standing up quickly (stand up slowly)

The third category is underrated. Patients often call or come back to ER for normal recovery symptoms because no one told them what to expect. Naming what's normal prevents unnecessary worry and healthcare use.

Specific Thresholds, Not Vague Warnings

Compare:

Vague: "Monitor your weight and call if it increases significantly."

Specific: "Weigh yourself every morning after you use the bathroom but before breakfast. Write it down. Call your doctor if you gain more than 3 pounds in one day or 5 pounds in one week."

The specific version tells patients exactly what to do, when to do it, and what threshold requires action.

The Teach-Back Method

Handing a patient discharge instructions and asking "Do you have any questions?" doesn't verify understanding. Most patients say "no" even when confused because they're overwhelmed, intimidated, or don't know what to ask.

Teach-back flips this. Instead of asking if they understand, ask them to explain it back to you.

How to Use Teach-Back

Frame it as your responsibility to explain clearly, not their responsibility to understand:

"I want to make sure I explained this clearly. Can you tell me how you'll take this new medication when you get home?"

Or: "To make sure we're on the same page, can you explain back to me what symptoms should make you call 911?"

This is non-judgmental. You're not testing them—you're checking your communication.

What to Verify

At minimum, verify patient or caregiver can explain:

• Why they were hospitalized and what happened
• Which medications changed and how to take new ones
• Warning signs that require immediate attention
• When and where follow-up appointments are
• Key self-care tasks (diet changes, wound care, activity restrictions)

For complex tasks (injections, wound care, using equipment), have them demonstrate the task before leaving.

Addressing Misunderstandings

When teach-back reveals misunderstanding, don't say "No, that's wrong." Instead: "Let me explain that part again in a different way."

Then re-explain using simpler language, pictures, or demonstrations. Verify understanding again. Don't discharge until critical information is understood.

Document teach-back in the medical record: "Patient able to state back warning signs requiring immediate attention. Patient demonstrated correct wound care technique. Questions answered about medication timing."

Follow-Up Appointments and Logistics

Patients are less likely to attend follow-up if the appointment isn't scheduled before discharge or if they're unclear on logistics.

Schedule Before Discharge When Possible

Instead of "Call your doctor within one week," try to schedule the appointment before patient leaves:

"Your follow-up appointment is scheduled for Monday, April 15 at 2:00pm with Dr. Smith at the cardiology clinic. The address is 123 Main Street, Suite 400 (parking in Lot B). The office phone is 555-1234 if you need to reschedule."

If you can't schedule it, provide specific timeline and contact info: "Call Dr. Smith's office at 555-1234 on Monday to schedule an appointment within 7 days of discharge."

Remove Logistical Barriers

Ask about potential barriers and address them before discharge:

• Transportation: "Do you have a way to get to your appointment?" If not, provide taxi vouchers, medical transport numbers, or community transportation resources.
• Pharmacy access: "Which pharmacy do you use?" Send prescriptions there electronically. If patient doesn't have pharmacy access or insurance, connect with social work for assistance.
• Language: If patient needs interpreter, note this and provide language line number or arrange interpreter for follow-up visits.
• Caregiver support: If patient can't manage self-care alone, is home health arranged? Does family understand their role?

Document barriers and how they were addressed. Unaddressed barriers become readmission risk factors.

Real Examples: Discharge Instructions That Reduced Readmissions

Example 1: Heart Failure Discharge Bundle

Problem: Hospital had 28% 30-day readmission rate for heart failure patients.

Solution: Created standardized, simplified discharge instructions with:

• One-page "quick guide" with only essential information (medications, daily weights, warning signs, appointments)
• Visual guide showing swelling progression ("call if your legs look like this")
• Pre-printed medication schedules (checkboxes for each dose)
• Scale provided to every patient going home
• Teach-back required for every discharge (documented in EMR)
• Follow-up phone call from nurse within 48 hours

Result: 30-day readmission rate dropped to 18% over 12 months. Patient satisfaction scores increased.

Example 2: Multilingual Diabetes Management

Problem: Spanish-speaking patients with diabetes being discharged with English-only instructions and unclear insulin instructions.

Solution:

• Created Spanish-language discharge instructions for common conditions
• Used certified medical interpreters for all discharge teaching
• Provided picture-based insulin instruction cards showing syringe measurements
• Connected patients with bilingual community health workers for post-discharge support
• Arranged follow-up at clinic with Spanish-speaking providers

Result: Readmission rates for Spanish-speaking diabetic patients dropped to match English-speaking patients. Hypoglycemia incidents post-discharge decreased.

Example 3: Surgical Recovery Instructions with Video

Problem: Patients discharged after orthopedic surgery unclear on physical therapy exercises and wound care, leading to complications.

Solution:

• Created patient-specific video demonstrations of prescribed exercises (recorded on patient's phone)
• Provided step-by-step photo guides for wound care specific to their incision
• Clear pain management plan with specific dosing schedule and non-medication options (ice, elevation)
• Loaner equipment (crutches, walker) provided before discharge with training
• Physical therapy appointment scheduled pre-discharge

Result: Post-surgical infection rates decreased. Patient-reported pain management improved. Physical therapy attendance increased.

Common Discharge Instruction Mistakes

Generic templates without customization. Every patient gets the same instructions regardless of actual diagnosis or needs. Customize to the individual.

No clear medication reconciliation. Patients don't know which meds changed, so they take both old and new doses or stop everything.

Warning signs too vague. "Call if symptoms worsen" is useless. Define symptoms and thresholds.

No verification of understanding. You hand them papers, they sign, they're gone. Use teach-back.

Ignoring literacy and language barriers. Instructions at 12th grade reading level in English only alienate patients who need clearer communication.

Discharge instructions reviewed too quickly. You're rushing to discharge before noon. Patient is overwhelmed, tired, distracted by family. They're not processing. Slow down or have someone else (nurse educator, pharmacist) review separately.

No follow-up plan. Patient leaves without scheduled appointments or way to get medications. Predictable readmission.

Key Takeaways

Effective discharge instructions prevent readmissions by ensuring patients understand how to care for themselves at home. They're written at appropriate literacy levels (5th-6th grade), free of unexplained jargon, and customized to the individual patient.

Medication instructions must clearly identify what's new, changed, or stopped—with specific dosing and timing. Activity and diet instructions need practical examples. Warning signs should be tiered by urgency with specific thresholds.

Use teach-back to verify understanding before discharge. Address logistical barriers (transportation, pharmacy access, language). Schedule follow-up appointments before patient leaves when possible.

The discharge instructions that work aren't the most comprehensive—they're the clearest, most actionable, and most tailored to the individual patient's needs and abilities.