1. Discharge Instructions: Understanding the Misunderstandings Summary and Comment by Richard D. Zane, MD, FAAEM Published in Journal Watch Emergency Medicine May 1, 2009Journal Watch Emergency Medicine Nearly 80% of patients did not understand some aspect of their ED care, usually discharge instructions, and most patients were not aware that they did not understand. CopyrightCopyright © 2009. Massachusetts Medical Society. All rights reserved.Massachusetts Medical Society

2. Covering Engel KG et al. Patient comprehension of emergency department care and instructions: Are patients aware of when they do not understand? Ann Emerg Med 2009 Apr; 53:454. CopyrightCopyright © 2009. Massachusetts Medical Society. All rights reserved.Massachusetts Medical Society

3. Background More and more inpatient care is being shifted to the outpatient environment, and patients are increasingly being asked to assume more responsibility for their own care. Patients’ ability to adhere to complex emergency department discharge instructions is directly related to how well they understand the instructions. In a prospective study conducted at two EDs in Michigan, researchers interviewed 140 patients immediately after ED discharge to assess their understanding of four categories of ED care: diagnosis and cause of symptoms, ED care received (tests and treatments), post-ED care (prescriptions, ancillary measures, follow-up), and symptoms that should prompt returning to the ED. Patients were allowed to look at their discharge instructions during questioning. CopyrightCopyright © 2009. Massachusetts Medical Society. All rights reserved.Massachusetts Medical Society

4. Background Investigators compared concordance between patients’ interview responses and information in their medical records and used the degree of concordance (none, minimal, partial, near, or complete) as an indicator of understanding. CopyrightCopyright © 2009. Massachusetts Medical Society. All rights reserved.Massachusetts Medical Society

5. The Research Overall, 78% of patients demonstrated some deficiency in comprehension (less than complete concordance) in at least one category, and 51% demonstrated deficiency in two or more categories. Most deficiencies in comprehension (34%) were related to post-ED care. Only 20% of patients with comprehension deficiencies were aware that they had them. CopyrightCopyright © 2009. Massachusetts Medical Society. All rights reserved.Massachusetts Medical Society

6. Comment ED staff need to be sure that patients “get it” before they leave. Asking them if they have any questions might not be enough. Perhaps we should ask patients to explain their diagnoses and treatment and follow-up plans to us in their own words. Ironically, we probably do more to ensure understanding when patients leave against medical advice than when they are simply discharged. If we are placing more responsibility for care on patients, we must make sure that they understand that expectation and can adhere to treatment; otherwise, we are doing them a disservice. CopyrightCopyright © 2009. Massachusetts Medical Society. All rights reserved.Massachusetts Medical Society

7. About Journal Watch Journal Watch helps physicians and allied heath professionals save time and stay informed by providing brief, clearly written, clinically focused perspectives on the medical developments that affect practice. Journal Watch is an independent, trustworthy source, from the publishers of the New England Journal of Medicine. These slides were derived from Journal Watch Emergency Medicine.Journal Watch Emergency Medicine The best way to stay informed with Journal Watch, is through our alerts. To sign up, visit the My Alerts page.My Alerts page CopyrightCopyright © 2009. Massachusetts Medical Society. All rights reserved.Massachusetts Medical Society