Artificial Intelligence-Supported Individualized Discharge Education After Coronary Artery Bypass Grafting

Patients undergoing elective isolated coronary artery bypass grafting will be enrolled and allocated to intervention and control groups using stratified randomization based on age, sex, and health literacy level. Randomization within each stratum will be performed using Randomizer.org.

Patients in the control group will receive the routine standard discharge education used in the cardiovascular surgery clinic. This education will include wound care, medication use, nutrition, physical activity, follow-up appointments, and warning signs after discharge.

Patients in the intervention group will receive the same standard education plus artificial intelligence-supported individualized discharge education. Individualized educational content will be prepared using standardized prompts adapted to each patient's age, sex, education level, health literacy, comorbidities, and surgical characteristics. The educational process will be structured according to Gagné's instructional events, including gaining attention, recalling prior knowledge, providing guidance, eliciting performance, and providing feedback. Teach-back questions will also be individualized to evaluate patient understanding and identify learning needs.

Baseline assessments will be performed 24-48 hours before discharge. Post-intervention assessments will be completed on the day of discharge. Follow-up assessments will be conducted on postoperative day 10 and at 1 month after discharge through clinic visits, telephone interviews, and patient records. Clinical outcomes will include postoperative recovery, readiness for discharge, discharge education satisfaction, self-care and medication adherence, complications, emergency department visits, and hospital readmissions.

Personally identifiable patient information will not be entered into the artificial intelligence system. All artificial intelligence-generated educational content will be reviewed by the research nurse and the relevant physician for clinical accuracy, safety, comprehensibility, and appropriateness before being delivered to patients.

• Artificial Intelligence-Supported Individualized Discharge Education (Behavioral): Participants will receive individualized discharge education supported by artificial intelligence in addition to routine standard discharge education. The content will be tailored to individual characteristics, health literacy, comorbidities, surgical characteristics, and learning needs. The education will be structured according to Gagné's instructional events and will include the teach-back method.
• Standard Discharge Education (Behavioral): Routine discharge education provided in the cardiovascular surgery clinic, including wound care, medication use, nutrition, physical activity, follow-up appointments, and warning signs after discharge.

Primary outcomes

• Postoperative Recovery Assessed Using the Post-Discharge Surgical Recovery Scale [10 days and 1 month after discharge]: Postoperative recovery will be assessed using the Post-Discharge Surgical Recovery Scale. The scale consists of 15 items, each scored from 1 to 10. The raw total score ranges from 15 to 150. Higher scores indicate better postoperative recovery. The scale evaluates postoperative recovery across areas including pain, mobility, self-care ability, activity level, and return to daily life.
• Unplanned Health Care Utilization Assessed by Emergency Department Visits and Hospital Readmissions [Within 30 days after discharge]: Unplanned health care utilization will be assessed based on emergency department visits and hospital readmissions occurring during the 30-day period after discharge. Information will be obtained through patient follow-up and, when available, verified using hospital records.

Secondary outcomes

• Change in Readiness for Hospital Discharge Assessed Using the Readiness for Hospital Discharge Scale-Short Form [Baseline (24-48 hours before hospital discharge) and within 1-3 days after the intervention]: Readiness for hospital discharge will be assessed using the Readiness for Hospital Discharge Scale-Short Form. The scale consists of 8 items, each scored from 0 to 10. Higher scores indicate greater readiness for hospital discharge. The scale assesses physical readiness, energy, knowledge regarding post-discharge care, ability to manage daily and personal care needs, and expected support after discharge. The scale will be administered at baseline and again on the day of hospital discharge to evaluate change in readiness for discharge.
• Satisfaction With Discharge Education Assessed Using the Discharge Education Satisfaction Scale for Surgical Patients [Within 1-3 days after the intervention]: Satisfaction with discharge education will be assessed using the Discharge Education Satisfaction Scale for Surgical Patients. The scale consists of 21 items rated on a 5-point Likert scale. Total scores range from 21 to 105, with higher scores indicating greater satisfaction with the discharge education received. The scale assesses patients' satisfaction with the adequacy, clarity, and content of discharge education.
• Postoperative Complications Assessed Through Patient Follow-up and Medical Records [Within 30 days after discharge]: Postoperative complications will be assessed through patient follow-up and medical records. Complications of interest will include surgical site infection, arrhythmia, and respiratory complications. When available, complication data will be verified using hospital records.

Sex: All, ages: 18 Years to any

Inclusion Criteria:

* Age 18 years or older.
* Having undergone elective isolated coronary artery bypass grafting.
* Ability to communicate in Turkish.
* No cognitive or communication impairment that would prevent participation in the study.
* Voluntary agreement to participate in the study and provision of written informed consent.

Exclusion Criteria:

* Refusal to participate in the study or failure to provide written informed consent.
* Age under 18 years.
* Inability to communicate in Turkish.
* Cognitive impairment, delirium, dementia, or a severe psychiatric condition preventing completion of the data collection tools.
* Having undergone emergency surgery.
* Presence of a severe postoperative complication preventing delivery of the planned discharge education.
* Inability to be reached during the follow-up period.
* Incomplete completion of the data collection forms.
* Withdrawal from the study at any stage.