Patient Understanding of Emergency Department Discharge Instructions: Where Are Knowledge Deficits Greatest?

• Published in: Academic emergency medicine 2012-09, Vol.19 (9), p.E1035-E1044
• Main Authors: Engel, Kirsten G., Buckley, Barbara A., Forth, Victoria E., McCarthy, Danielle M., Ellison, Emily P., Schmidt, Michael J., Adams, James G.
• Format: Article
• Language: English
• Subjects: Adult; Chi-Square Distribution; Cohort Studies; Comprehension; Educational Status; Emergency medical care; Emergency Service, Hospital; Female; Follow-Up Studies; Health Knowledge, Attitudes, Practice; Humans; Interviews as Topic; Knowledge; Length of Stay; Male; Medical diagnosis; Mental Recall; Middle Aged; Patient Compliance - statistics & numerical data; Patient Discharge; Patient Education as Topic; Prospective Studies; Risk assessment; Risk Factors; Statistics, Nonparametric; Time Factors
• ISSN: 1069-6563; 1553-2712
• DOI: 10.1111/j.1553-2712.2012.01425.x

ACADEMIC EMERGENCY MEDICINE 2012; 19:1035–1044 © 2012 by the Society for Academic Emergency Medicine Objectives:  Many patients are discharged from the emergency department (ED) with an incomplete understanding of the information needed to safely care for themselves at home. Patients have demonstrated particular difficulty in understanding post‐ED care instructions (including medications, home care, and follow‐up). The objective of this study was to further characterize these deficits and identify gaps in knowledge that may place the patient at risk for complications or poor outcomes. Methods:  This was a prospective cohort, phone interview–based study of 159 adult English‐speaking patients within 24 to 36 hours of ED discharge. Patient knowledge was assessed for five diagnoses (ankle sprain, back pain, head injury, kidney stone, and laceration) across the following five domains: diagnosis, medications, home care, follow‐up, and return instructions. Knowledge was determined based on the concordance between direct patient recall and diagnosis‐specific discharge instructions combined with chart review. Two authors scored each case independently and discussed discrepancies before providing a final score for each domain (no, minimal, partial, or complete comprehension). Descriptive statistics were used for the analyses. Results:  The study population was 50% female with a median age of 41 years (interquartile range [IQR] = 29 to 53 years). Knowledge deficits were demonstrated by the majority of patients in the domain of home care instructions (80%) and return instructions (79%). Less frequent deficits were found for the domains of follow‐up (39%), medications (22%), and diagnosis (14%). Minimal or no understanding in at least one domain was demonstrated by greater than two‐thirds of patients and was found in 40% of cases for home care and 51% for return instructions. These deficits occurred less frequently for domains of follow‐up (18%), diagnosis (3%), and medications (3%). Conclusions:  Patients demonstrate the most frequent knowledge deficits for home care and return instructions, raising significant concerns for adherence and outcomes. Resumen Objetivos:  Un gran número de pacientes son dados de alta desde el servicio de urgencias (SU) con una comprensión deficitaria de la información necesaria para un cuidado seguro de sí mismos en el domicilio. Los pacientes tienen una dificultad especial en comprender las instrucciones a seguir tras su atención en el SU