Another Dimension of Safe Care: ED Discharge Instructions

Article by: Mary Lacher, MD, JCR Consultant

A recent article in the Annals of Emergency Medicine¹ found disturbing statistics when evaluating a patient’s understanding of their diagnosis and discharge instructions after leaving the emergency department (ED).  The study found that 78% of patients had a deficiency in understanding their diagnosis/cause, ED care, recommended post ED care or return instructions. 

Emergency department discharge instructions often do not meet patient’s needs.  Many institutions still use handwritten instructions from the physicians.  The information is not uniform among caregivers.   Often time, they are written on carbon copies and difficult to read.  Another system utilized by EDs is to print instructions from different web based sites.  These tend to be several pages long and often times of questionable accuracy.  In addition, they may be written at a reading level that many patients may not understand.  Patients are less likely to read a several page web handout than a simple one page informational sheet.

Pediatric patients present a unique need in this area.  The majority of pediatric emergency room patients are not treated in a pediatric hospital emergency room or cared for by physicians specially trained in pediatric emergency medicine. Too often, they are treated as adults and given instructions that do not take into account pediatric development, disease progression and their unique physiology.  In addition, there are specific diseases entities that are present in the pediatric population that often times adult- trained emergency physician are unfamiliar with and do not fully understand.

Ideally, discharge instructions should be a single page and written at a 5-7^th grade reading level (see examples below). In addition, pediatric instructions should take into account their unique disease processes, progression and pediatric physiology.  It should provide the patient (parent) with accurate, uniform, concise information that includes the following: 

·        Signs, symptoms and expected progression of the diagnosed condition. 

·        Explanation of how it is treated. 

·        Instructions on when to follow-up with their regular doctor or return to the emergency room

The more a patient is involved and understands their care, the less likely there will be complications or worsening of the disease process.  Proper educational discharge instructions play a crucial role in this process.

¹ Engel, KG; Heisler, M.; Smith, DM; Robinson, CH; Forman, JH; Ubel, PA: Patient Comprehension of Emergency Department Care and Instructions: Are Patients Aware of When They Do Not Understand,  Annals of Emergency Medicine, 2008 Jul. 10 [Epub ahead of print]

Read Mary Lacher's biography.