Tuesday, May 3, 2011

Clear Discharge Instructions from Emergency department are Critical

Verbal Discharge Instructions Are Often Incomplete

Few emergency department patients received full discharge instructions, and patients' understanding of the instructions was rarely assessed.

Clear discharge instructions are an important communication tool and an essential part of an emergency department (ED) visit. Researchers analyzed audio-recorded verbal discharge instructions for 477 adult female patients at two EDs to assess inclusion of nine components of the instructions and to evaluate the quality of each component (minimal, adequate, or excellent).

Most patients were given an opportunity to ask questions (91%), although the quality of the interaction was usually minimal. Most patients also were given instructions about medications (80%), an explanation of their symptoms (76%), instructions about follow-up care (73%), and instructions about self-care (69%). Fewer patients received an explanation of their expected course of illness (51%), recommendations for a specific time for follow-up (39%), or instructions about symptoms that should prompt return to the ED (34%). Patients were rarely given an opportunity to confirm understanding of the instructions (22%), and, when they were, the quality of the interaction was usually minimal.

Comment: Discharge instructions, at the very least, should provide each of the above components, particularly clear instructions regarding the symptoms that should prompt further evaluation. Lack of clear discharge instructions often is a key element in medical malpractice suits.

— Richard D. Zane, MD, FAAEM

Published in Journal Watch Emergency Medicine April 29, 2011

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