MIA 2012: Samuels-Kalow ME et al. Effective discharge communication in the emergency department. Ann Emerg Med. 2012 Aug;60(2):152-9

Bottom Line:

This study tells us what we might already suspect: in the busy, hectic and loud Emergency Department, patients we discharge often lack comprehension of their hospital course. Additionally, they are frequently unable to report their diagnosis, a discharge plan or reasons they should return to the ED. 

Why It’s Important to Emergency Medicine:

When a patient leaves the hospital failing to fully understand their discharge plan, they become open to the potential risk of medication error or adverse drug event.  Key elements leading to a lack of understanding by patients include

1. Providers not explaining symptoms
2. Not explaining which symptoms should prompt a return ED visit
3. Presenting material at inappropriately high reading level or not in a patient's native language

Major Points:

Patients do not understand our discharge instructions! When you combine this with confusion about what happened in the hospital, they’re unhappy with their visit. Unhappy patients are less likely to fill prescriptions and attend follow up appointments. Patients need structured content, presented both visually and verbally, at an educational level they can understand. This teaching should communicate crucial information, verify comprehension, and address areas of misunderstanding to ensure patient safety. 

• If you want to improve patient mortality, provide organized and standardized discharge instructions.  
• If you want patients to remember their diagnosis, provide written material.  
• If you want patients to go to their follow up appointments, provide them with a scheduled appointment at the time of discharge and explain to them exactly why follow up is essential.

Design:

MEDLINE and Cochrane databases were searched for relevant articles, with a single reviewer examining abstracts for relevant articles.  Both adult and pediatric literature was included.

Criticisms:

As the authors mention, implementation of potential interventions to improve patient comprehension and implementation of discharge plans seem infeasible in the ED setting.

Reviewed by P. Corey

Reference

Samuels-Kalow ME, Stack AM, Porter SC. Effective discharge communication in the emergency department. Ann Emerg Med. 2012 Aug;60(2):152-9. Pubmed

MIA 2012 = Most Interesting Articles series of 2012