Date of Award


Document Type


Degree Name

Doctor of Nursing (ND)


Biological Science

First Advisor

Cartwright, JoAnna

Second Advisor

Awes, Kelly Marie


A lack of comprehension of discharge instructions may cause high readmission and emergency room revisit rates for organizations. At the project site, there was no current evidence-based practice to ensure patient comprehension of discharge instructions. The purpose of this quantitative, quasi-experimental quality improvement project was to determine if the implementation of the Institute for Healthcare Improvement (IHI) Always Use Teach-Back Toolkit would impact emergency room revisit rates among adult medical-surgical patients in a critical access hospital in rural Minnesota over four weeks. Afaf Meleis’ transitions theory and the Iowa model for evidence-based practice were the scientific underpinnings of the project. The total sample size was 87, n = 47 in the comparison and n = 40 in the intervention groups. Data was extracted from the facility’s electronic health record. A chi-squared test was used, and results indicated no statistically significant reduction in the ED revisit rates X 2 (1, n=87) =2.00, p=0.157. Clinical significance is found in reducing the ED revisit rates by 1.38% over the four weeks. Therefore, the implementation of the IHI’s Always Use Teach-Back Toolkit may reduce emergency room revisit rates in this population and setting. Recommendations include sustaining the practice, adding teach-back to the discharge planning protocol, and disseminating the project findings.


A Direct Practice Improvement Project Presented in Partial Fulfillment of the Requirements for the Degree Doctor of Nursing Practice

Grand Canyon University Phoenix, Arizona December 9, 2021