Patient understanding of discharge instructions in the emergency department: do different patients need different approaches?

Patient understanding of discharge instructions in the emergency department: do different patients need different approaches? Hasan Sheikh1*, Aleksandar Brezar2, Agata Dzwonek2, Lawrence Yau2 and Lisa A. Calder3,4 Abstract Background: Previous studies have demonstrated that patients have poor understanding of the discharge instructions provided from the emergency department (ED). The aims of this study are to determine if patient factors, such as income and level of education, correlate with patient understanding of discharge instructions and to explore if different patient populations prefer different resources for receiving discharge instructions. Methods: We conducted live observations of physicians providing discharge instructions in the ED to 100 patients followed by a patient survey to determine their understanding in four domains (diagnosis, treatment plan, followup instructions, and return to ED (RTED) instructions) and collect patient demographics. We enrolled patients over the age of 18 being discharged home. We excluded non-English- or French-speaking patients and those with significant psychiatric history or cognitive impairment. We performed a two-way ANOVA analysis of patient factors and patient understanding. Results: We found that patients had poor understanding of discharge instructions, ranging from 24.0% having poor understanding of their follow-up plan to 64.0% for RTED instructions. Almost half (42%) of patients did not receive complete discharge instructions. Lower income was correlated with a significant decrease in patient understanding of discharge diagnosis (p = 0.01) and RTED instructions (p = 0.04). Patients who did not complete high school trended towards lower levels of understanding of their diagnosis and treatment plan (p = 0.06). Lower income patients had a preference for receiving a follow-up phone call by a nurse, while higher income patients preferred online resources. Conclusions: Lower income patients and those who have not completed high school are at a higher risk of poor understanding discharge instructions. As new technological solutions emerge to aid patient understanding of discharge instructions, our study suggests they may not aid those who are at the highest risk of failing to understand their instructions.

ANSWER. PAPER DETAILS
Academic Level	Masters
Subject Area	Nursing
Paper Type	Article Critique
Number of Pages	1 Page(s)/275 words
Sources	0
Format	APA
Spacing	Double Spacing

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