Sometimes hospitalized patients hear clinicians' instructions, but they don't always understand them. When the patients return home, misunderstandings or confusion can lead to medication mishaps or other missteps that land them back in the hospital. That's where teach-back training can help — by preventing communication breakdowns that can worsen patient outcomes and increase health care costs.

In February, UnityPoint Health, formerly Iowa Health System in West Des Moines launched the "Always Use Teach-back!" toolkit for health care providers. Interactive modules demonstrate how to ask patients or family members to repeat — in their own words — what they should know or do.

Clinicians can apply the recommended elements of teach-back competence, such as displaying a caring tone of voice and attitude, comfortable body language and eye contact. Other elements include using plain language, phrasing open-ended questions in a non-shaming manner and offering patient-friendly printed materials.

"A vulnerable person may think that we're testing their knowledge. That's not what we want," says Gail Nielsen, director of learning and innovation at the health system's Center for Clinical Transformation. "We want to know what they're learning. If they're not learning what we thought we taught them, then we can say it in a different way."

The online site provides round-the-clock accessibility to anyone. It's in sync with the Institute for Healthcare Improvement's efforts to enhance health literacy across the nation.

Darren DeWalt, M.D., relies on this method, particularly for patient self-management. "I often use teach-back when I am adjusting medications, and I will ask, 'Tell me again how you are going to change your medicine? I want to make sure I was clear in my communication.' " says DeWalt, an associate professor of medicine at the University of North Carolina–Chapel Hill.

Teach-back has a high success rate. "The amount of time spent teaching was significantly associated with the patient's ability to correctly answer the teach-back information, indicating a need for dedicated teaching time for bedside nurses to improve patients' understanding of their condition," says Matthew White, R.N., lead author of a heart failure study published in the March/April issue of the Journal of Cardiovascular Nursing and an acute care nurse practitioner at the University of California San Francisco Medical Center.

Patients leaving the hospital may be especially overwhelmed, drowsy from pain medication and unable to grasp details in discharge instructions, says Doreen Finn, R.N., senior associate director of the Standards Interpretation Group at the Joint Commission. But with effective teach-back, she says, "they don't go home and get confused about what they're supposed to do."