Patient Comprehension of Emergency Department Care and Instructions: Are Patients Aware of When They Do Not Understand?

Engel, Kirsten G.; Heisler, Michele; Smith, Dylan M.; Robinson, Claire; Forman, Jane; Ubel, Peter A.

doi:10.1016/j.annemergmed.2008.05.016

Cited by 254 publications

(245 citation statements)

References 24 publications

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“…These interventions are resource-intensive and have had only intermittent success in decreasing hospitalizations, reducing ED visits, increasing primary care visits, and improving functional outcomes. [7][8][9][10][11][12][13][14] Several studies have found that comprehension of discharge instructions is a significant barrier to care compliance [15][16][17][18] and that many older patients discharged from the ED do not understand their discharge instructions, nor do they attend follow-up appointments. 18,19 Studies conducted in other patient populations have shown that telephone follow-up encourages compliance with discharge instructions and increases the likelihood of physician follow-up.…”

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confidence: 99%

A Randomized Trial Exploring the Effect of a Telephone Call Follow‐up on Care Plan Compliance Among Older Adults Discharged Home From the Emergency Department

Biese

LaMantia

Shofer

et al. 2014

Academic Emergency Medicine

120

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Objectives: Older patients discharged from the emergency department (ED) have difficulty comprehending discharge plans and are at high risk of adverse outcomes. The authors investigated whether a postdischarge telephone call-mediated intervention by a nurse would improve discharge care plan adherence, specifically by expediting post-ED visit physician follow-up appointments and/or compliance with medication changes. The second objectives were to determine if this telephone call intervention would reduce return ED visits and/or hospitalizations within 35 days of the index ED visit and to determine potential cost savings of this intervention.Methods: This was a 10-week randomized, controlled trial among patients aged 65 and older discharged to home from an academic ED. At 1 to 3 days after each patient's index ED visit, a trained nurse called intervention group patients to review discharge instructions and assist with discharge plan compliance; placebo call group patients received a patient satisfaction survey call, while the control group patients were not called. Data collection calls occurred at 5 to 8 days and 30 to 35 days after the index ED visits for all three groups. Chi-square or Fisher's exact tests were performed for categorical data and the Kruskal-Wallis test examined group differences in time to follow-up.Results: A total of 120 patients completed the study. Patients were 60% female and 72% white, with a mean age of 75 years (standard deviation [SD] AE 7.58 years). Intervention patients were more likely to follow up with medical providers within 5 days of their ED visits than either the placebo or the control group patients (54, 20, and 37%, respectively; p = 0.04). All groups performed well in medication acquisition and comprehension of medication indications and dosage. There were no differences in return visits to the ED or hospital within 35 days of the index ED visit for intervention patients, compared to placebo or control group patients (22, 33, and 27%, respectively; p = 0.41). An economic analysis showed an estimated 70% chance that this intervention would reduce total costs. Conclusions:Telephone call follow-up of older patients discharged from the ED resulted in expedited follow-up for patients with their primary care physicians. Further study is warranted to determine if

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confidence: 99%

A Randomized Trial Exploring the Effect of a Telephone Call Follow‐up on Care Plan Compliance Among Older Adults Discharged Home From the Emergency Department

Biese

LaMantia

Shofer

et al. 2014

Academic Emergency Medicine

120

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“…There is evidence that practicing physicians and nurses fail to consistently manage these challenges. [7][8][9][10][11] Trainees are put into an environment that is unfamiliar and unpredictable, where their teachers have very little time to teach and do not always role model effectively.…”

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confidence: 99%

Teaching the RAPID approach at the start of emergency medicine clerkship: an evaluation

Woods

Trinder

D’Eon

et al. 2014

CJEM

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Background: The RAPID approach (Resuscitation, Analgesia and assessment, Patient needs, Interventions, Disposition) was developed as an approach to managing emergency department patients. It is a mental checklist to help trainees provide comprehensive care, addressing issues in priority. Its impact on trainee performance has not been assessed. Methods: Forty-two clerkship students were enrolled, with 21 students in each group. They received or did not receive the teaching intervention on an alternate basis. Students were assessed through daily encounter cards, a case presentation, a self-assessment form, a prerotation case (case E), and a sixcase short-answer exit examination (cases A to F) with case E repeated. Case E was designed specifically to assess students' ability to provide comprehensive care. Fourteen students participated in focus groups. Results: Students in the intervention group had significantly higher exit examination case E scores (11.67 of 14 v. 10.26 of 14, p 5 0.008) and improvement in their case E scores from pre-to postrotation (1.82 v. 0.26, p 5 0.006). There were no significant differences in the other outcome measures. Intervention group students made positive comments around analgesia, addressing nonmedical needs and counseling on health promotion during focus groups. Conclusions: Students exposed to the RAPID approach at the start of their emergency medicine rotation performed better on the one component of the written examination for which it was designed to improve performance. Students found it to be a useful mental checklist for comprehensive care, possibly addressing the hidden curriculum. Emergency medicine educators should consider further study and careful implementation of the RAPID approach.

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“…As a result we are dependent on our clinical judgement of the patient's stability as well as the understanding and capability of the parents in safely discharging pediatric patients. Up to 75% of patients/ parents do not understand the instructions given at the time of emergency department discharge and not surprisingly almost all malpractice complaints arising from the emergency department have incomplete discharge instructions as a component [1].CMS guidelines mandate discharge instructions be written in appropriate language, at no more than a 5 th -7 th grade reading level, and specifically address description of signs and symptoms associated and expected during the progression of the illness [2,3]. CMS also comments that generic discharge instructions for the emergency department as a whole do not adequately address the unique needs of pediatric emergency medicine and should be individually tailored to the pediatric patient.…”

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Safe Discharge from the Pediatric Emergency Department

Waldrop¹

2014

JPNC

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The future condition of pediatric patients discharged from the emergency department can never be guaranteed even when the diagnosis has been clearly defined. As a result we are dependent on our clinical judgement of the patient's stability as well as the understanding and capability of the parents in safely discharging pediatric patients. Up to 75% of patients/ parents do not understand the instructions given at the time of emergency department discharge and not surprisingly almost all malpractice complaints arising from the emergency department have incomplete discharge instructions as a component [1].CMS guidelines mandate discharge instructions be written in appropriate language, at no more than a 5 th -7 th grade reading level, and specifically address description of signs and symptoms associated and expected during the progression of the illness [2,3]. CMS also comments that generic discharge instructions for the emergency department as a whole do not adequately address the unique needs of pediatric emergency medicine and should be individually tailored to the pediatric patient. Below are some guidelines for safe discharge from the pediatric emergency department. Objectively assess physiologic stability by directly evaluating vital signs and clearly document this cognitive process in the medical recordNormal values are readily available in texts. Do not depend on observations by nurses and other ancillary personnel and contemplate the implications of each vital sign. This should be the culmination of a series of observations throughout the emergency department stay. Always document vital sign course, stabilization, and conclusions at the time of discharge fully. Teach parents how to measure heart rate and respiratory rate as well as acceptable values.

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Patient Comprehension of Emergency Department Care and Instructions: Are Patients Aware of When They Do Not Understand?

Cited by 254 publications

References 24 publications

A Randomized Trial Exploring the Effect of a Telephone Call Follow‐up on Care Plan Compliance Among Older Adults Discharged Home From the Emergency Department

A Randomized Trial Exploring the Effect of a Telephone Call Follow‐up on Care Plan Compliance Among Older Adults Discharged Home From the Emergency Department

Teaching the RAPID approach at the start of emergency medicine clerkship: an evaluation

Safe Discharge from the Pediatric Emergency Department

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