Patients Lack Comprehension of Discharge Instructions
A report published in the Annals of Emergency Medicine notes that many patients do not comprehend their discharge instructions (pdf) when leaving the emergency room. This will be come increasingly important as efforts are directed to decreasing overuse of emergency facilities.
The research team, including researchers from both the University of Michigan and Northwestern University, completed an effort to evaluate patient’s level of understanding instructions at the time of discharge. Another factor that the team evaluated was whether patients were aware that they were not understanding the guidance.
Interviews with 140 English speaking patients or their primary caregivers were completed after patient discharge. Four areas of comprehension were rated by those individuals: diagnosis and cause, ED care, post-ED care, and return instructions.
Findings from self-ratings were compared to patient charts. The degree of concordance between the recall and chart was determined based on this assessment. Independent scoring was completed by two different reviewers, who later conferred before determining a final rating of concordance.
The significant majority (78 percent) of patients had deficient comprehension in at least one of the four areas. Just over half (51 percent) had deficiency in two areas. About one-third of the confusion was about care after leaving the ED. And, few patients were aware that they did not understand the information provided.
These findings are important, as failure to understand guidance can result in adverse outcomes and return to the emergency room. It is critical that clinicians engage with patients to determine their level of comprehension before discharge. It further suggests that standard forms and information provided to patients when leaving the hospital require an overhaul.
July 15, 2008 Related topics: Quality, Safety, Errors, Emergency