Older Patients' Understanding of Emergency Department Discharge Information and Its Relationship With Adverse Outcomes

Hastings, S. Nicole; Barrett, Amanda; Weinberger, Morris; Oddone, Eugene Z.; Ragsdale, Luna; Hocker, M.; Schmader, Kenneth E.

doi:10.1097/pts.0b013e31820c7678

Cited by 79 publications

(101 citation statements)

References 27 publications

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“…2,6,7,29 Non-comprehension has also been observed to vary across domains of the discharge instructions. 29 Social isolation was strongly associated with noncomprehension of the exercise instructions in this study, adding to prior reports of social isolation as a predictor of non-compliance.…”

Section: Discussionmentioning

confidence: 99%

“…Nonetheless, patients do not always understand these instructions. [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.…”

Section: Introductionmentioning

confidence: 99%

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Hospital Discharge Instructions: Comprehension and Compliance Among Older Adults

et al. 2014

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BACKGROUND: Little is known regarding the prevalence or risk factors for non-comprehension and noncompliance with discharge instructions among older adults. OBJECTIVE: To quantify the prevalence of noncomprehension and non-compliance with discharge instructions and to identify associated patient characteristics. RESEARCH DESIGN: Prospective cohort study. SUBJECTS: Four hundred and fifty adults aged ≥ 65 admitted to medical and surgical units of a tertiary care facility and meeting inclusion criteria. MEASURES: We collected information on demographics, psycho-social factors, discharge diagnoses, and medications using surveys and patient medical records. Domains within discharge instructions included medications, follow-up appointments, diet, and exercise. At 5 days post-discharge, we assessed comprehension by asking patients about their discharge instructions, and compared responses to written instructions from medical charts. We assessed compliance among patients who understood their instructions. RESULTS: Prevalence of non-comprehension was 5 % for follow-up appointments, 27 % for medications, 48 % for exercise and 50 % for diet recommendations. Age was associated with non-comprehension of medication [odds ratio (OR) 1.07; 95 % confidence interval (CI) 1.04, 1.12] and follow-up appointment (OR 1.08; 95 % CI 1.00, 1.17) instructions. Male sex was associated with noncomprehension of diet instructions (OR 1.91; 95 % CI 1.10, 3.31). Social isolation was associated with noncomprehension of exercise instructions (OR 9.42; 95 % CI 1.50, 59.11) Depression was associated with noncompliance with medication (OR 2.29; 95 % CI 1.02, 5.10) and diet instructions (OR 3.30; 95 % CI 1.24, 8.83). CONCLUSIONS: Non-comprehension of discharge instructions among older adults is prevalent, multifactorial, and varies by domain.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Hospital Discharge Instructions: Comprehension and Compliance Among Older Adults

et al. 2014

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“…[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. [20][21][22][23] Prior work has also shown that telephone follow-up interviews are feasible among older patients discharged from the ED.…”

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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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“…[1][2][3][4] Despite a trend favoring increased testing, prolonged periods of observation, and higher admission rates, studies have shown worse emergency department (ED) outcomes in this population. [5][6][7] In response to the geriatric demographic imperative, leaders from the Society for Academic Emergency Medicine (SAEM) and the American College of Emergency Physicians (ACEP) recommend modifying the model of emergency health care delivery to better care for older adults. 1,[8][9][10] Strategies for improved ED elder care range from the education and attitude change of emergency providers to the redesign of ED physical plants and departmental operational changes.…”

mentioning

confidence: 99%

“…[5][6][7] It took only 10 years to establish stroke center certification, which is a targeted single disease process. It required about 20 years developing certified pediatric EDs, as this certification involves care of a population through a spectrum of diseases.…”

mentioning

confidence: 99%

A Profile of Acute Care in an Aging America: Snowball Sample Identification and Characterization of United States Geriatric Emergency Departments in 2013

Hogan

Olade

Carpenter

2014

Academic Emergency Medicine

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Background: The aging of America poses a challenge to emergency departments (EDs). Studies show that elderly patients have poor outcomes despite increased testing, prolonged periods of observation, and higher admission rates. In response, emergency medicine (EM) leaders have implemented strategies for improved ED elder care, enhancing expertise, equipment, policies, and protocols. One example is the development of geriatric EDs gaining in popularity nationwide. To the authors' knowledge, this is the first research to systematically identify and qualitatively characterize the existence, locations, and features of geriatric EDs across the United States.

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Older Patients' Understanding of Emergency Department Discharge Information and Its Relationship With Adverse Outcomes

Abstract: A substantial number of older patients, or proxies, may not understand ED discharge information, and this could have an effect on patient outcomes. Strategies are needed to improve communication of ED discharge information to older patients and their families.

Cited by 79 publications

References 27 publications

Hospital Discharge Instructions: Comprehension and Compliance Among Older Adults

Hospital Discharge Instructions: Comprehension and Compliance Among Older Adults

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 Profile of Acute Care in an Aging America: Snowball Sample Identification and Characterization of United States Geriatric Emergency Departments in 2013

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