Emergency department discharge instructions comprehension and compliance study

Abstract

Objectives: To assess patient comprehension of emergency department discharge instructions and to describe other predictors of patient compliance with discharge instructions. Methods: Patients departing from the emergency department of an inner-city teaching hospital were invited to undergo a structured interview and reading test, and to participate in a follow-up telephone interview 2 weeks later. Two physicians, blinded to the other's data, scored patient comprehension of discharge information and compliance with discharge instructions. Inter-rater reliability was assessed using a kappa-weighted statistic, and correlations were assessed using Spearman's rank correlation coefficient and Fisher's exact test. Results: Of 106 patients approached, 88 (83%) were enrolled. The inter-rater reliability of physician rating scores was high (kappa = 0.66). Approximately 60% of subjects demonstrated reading ability at or below a Grade 7 level. Comprehension was positively associated with reading ability (r = 0.29, p = 0.01) and English as first language (r = 0.27, p = 0.01). Reading ability was positively associated with years of education (r = 0.43, p < 0.0001) and first language (r = 0.24, p = 0.03), and inversely associated with age (r = -0.21, p = 0.05). Non-English first language and need for translator were associated with poorer comprehension of discharge instructions but not related to compliance. Compliance with discharge instructions was correlated with comprehension (r = 0.31, p = 0.01) but not associated with age, language, education, years in anglophone country, reading ability, format of discharge instructions, follow-up modality or association with a family physician. Conclusions: Emergency department patients demonstrated poor reading skills. Comprehension was the only factor significantly related to compliance; therefore, future interventions to improve compliance with emergency department instructions will be most effective if they focus on improving comprehension. RÉSUMÉObjectifs : Évaluer la compréhension des patients des recommandations lors de leur congé du département d'urgence et décrire d'autres prédicteurs de respect de ces recommandations.

The Readmission Reduction Program of Kaiser Permanente Southern California—Knowledge Transfer and Performance Improvement

“…They may be eager to leave and less interested in the instructions. 21 The bundle elements discussed in this article are designed to address the social issues that may result in an avoidable readmission to the hospital. It appears that a bundle of elements will be needed to successfully reduce readmission rates in the Medicare risk contract population.…”

What to do when a patient wants to record a patient-physician interaction in the emergency department

“…We know how little patients remember from their time in the ED, and few can recall their discharge or follow-up instructions. 26 There are, however, important reasons why physicians may not want to be recorded. Physicians, like any other private citizen, have a reasonable expectation to privacy in their workplace.…”

Hospital Discharge Instructions: Comprehension and Compliance Among Older Adults

“…[1][2][3][4][5][6][7][8] Non-comprehension of the discharge instructions is associated with decreased compliance and could lead to poor health outcomes. 1,9 Previous studies that have assessed patient comprehension of the discharge instructions have been primarily conducted in emergency departments and have not focused on older adults, who represent a disproportionate share of healthcare users. 3,4,6,[9][10][11] Furthermore, increased complexity of the discharge instructions due to a greater burden of comorbid illnesses and higher prevalence of cognitive impairment among older adults may result in an elevated risk of non-comprehension.…”

“…1,9 Previous studies that have assessed patient comprehension of the discharge instructions have been primarily conducted in emergency departments and have not focused on older adults, who represent a disproportionate share of healthcare users. 3,4,6,[9][10][11] Furthermore, increased complexity of the discharge instructions due to a greater burden of comorbid illnesses and higher prevalence of cognitive impairment among older adults may result in an elevated risk of non-comprehension. 1,2,[12][13][14] In this study, we determined the prevalence of noncomprehension of the discharge instructions and identified patient characteristics associated with non-comprehension among older adults discharged from the medical and surgical units of a large urban hospital.…”