Patient Discharge Instructions in the Emergency Department and Their Effects on Comprehension and Recall of Discharge Instructions: A Systematic Review and Meta-analysis

Hoek, Amber E.; Anker, Susanne C.P.; Beeck, Ed F. van; Burdorf, Alex; Rood, Pleunie P.M.; Haagsma, Juanita A.

doi:10.1016/j.annemergmed.2019.06.008

Cited by 100 publications

(104 citation statements)

References 66 publications

(123 reference statements)

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“…A list of behaviours must be understood, recalled and acted upon. However, patients typically cannot recall a substantial amount of relevant information, with recollections being sensitive to format (Hoek et al, 2020). Verbal communication is recalled less than written information or, better still, video.…”

Section: Hypothesis 2cmentioning

confidence: 99%

Using decision aids to support self-isolation during the COVID-19 pandemic

Lunn

Timmons

Julienne

et al. 2020

Psychology & Health

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Objective: Self-isolation is a vital element of efforts to contain COVID-19. We set out to test whether decision aids can support self-isolation. Design: We conducted a pre-registered online experiment with a nationally representative sample (n ¼ 500). Three stages tested: (i) whether decision trees help people to decide whether they need to self-isolate; (ii) whether an online planning tool increases people's confidence in their ability to self-isolate; and (iii) whether infographics help people to absorb advice on managing a household in which someone must self-isolate. Main Outcome Measures: (i) Accuracy of matching symptom patterns to a response scale for the need to self-isolate; (ii) selfreported confidence in coping with self-isolation; (iii) objective tests of recall and comprehension. Results: Decision trees improved decisions about when self-isolation was necessary, although participants systematically underestimated the need to self-isolate with less common COVID-19 symptoms (e.g. sore throat, fatigue). The online planning tool increased confidence about coping with self-isolation only among the adults aged under 40. Infographics improved recall and comprehension of how to manage self-isolation. Conclusion: Decision aids can be used to support self-isolation during COVID-19. The study also demonstrates how even an emergency public health response can benefit from rapid experimental pre-testing of interventions.

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Section: Hypothesis 2cmentioning

confidence: 99%

Using decision aids to support self-isolation during the COVID-19 pandemic

Lunn

Timmons

Julienne

et al. 2020

Psychology & Health

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“…In our study, patients perceive their understanding of the treatment plan good to very well. However, many studies have shown that patients regularly do not understand their treatment plan or discharge instructions [35,36]. More importantly, most patients appear to be unaware of their lack of understanding, which might be also the case in our study and an explanation for the high scores [37,38].…”

Section: Plos Onementioning

confidence: 47%

Quality of acute internal medicine: A patient-centered approach. Validation and usage of the Patient Reported Measure-acute care in the Netherlands

et al. 2020

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Background Providing high quality care is important and has gained more attention since the introduction of value-based healthcare. Value should be measured by outcomes achieved, relevant for patients. Patient-centeredness is one domain for quality improvement determined by the Institute of Medicine, aiming to deliver care responsive to the patient. The development and implementation of patient reported outcome- and experience measures can be used for this goal. Recently, we developed the Patient Reported Measure (PRM)-acute care, based on five relevant domains to evaluate and improve the quality of care in the Emergency Department (ED). Objective To validate the PRM-acute care, in order to evaluate and improve patient-centered care in the ED. Methods We performed a prospective questionnaire-based study. Patients ≥18 years presenting for internal medicine in the ED were eligible. The validity of the PRM-acute care was evaluated according to the COSMIN-criteria. We performed hypotheses testing to evaluate construct validity. The perceived quality of care was evaluated by statistical analysis. Results Face- and content validity was evaluated based on previously performed research and deemed good. Construct validity was supported by demonstrated differences between subgroups; patients with severe symptoms had a higher perceived quality of care. The correlation between overall satisfaction and the total mean score of the PRM-acute care (r = 0,447, p = 0.01) was significant. Overall, patients reported a mean perceived quality of care of 4.67/6.0. Conclusion The PRM-acute care is a valid instrument to measure the perceived quality of care in an acute setting for internal medicine patients. Additionally, patients reported a good perceived quality of care in the ED with scores ranging from moderate to well for each of the relevant domains. Therefore, we believe that the PRM-acute care can be implemented in daily practice to evaluate the perceived quality of care and to improve the quality of acute care.

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“…Our findings support recent evidence that the addition of written discharge instructions to verbal instructions shows promise for the ED population. 4 However, the provision of printed and mobile accessible discharge instructions for pain relief advice was not associated with a difference between groups for our primary outcomes. Other studies using pain scores as primary outcomes for pain management interventions at ED discharge usually focus on comparing the efficacy of different analgesic regimes.…”

Section: Discussionmentioning

confidence: 74%

“…Verbal instructions are standard in the ED discharge process. 4 These are often incomplete and brief, averaging 76 s. 5 Written ED discharge instructions can be a handwritten or typed letter, a pre-formatted instruction sheet to be filled out or a generic pre-printed education document. 6 A recent systematic review and meta-analysis found that the addition of written to verbal instructions at ED discharge may increase patient recall from 47% to 58% on average 4 although readability levels of written discharge instructions are found to be consistently higher than the levels recommended for the general population.…”

Section: Introductionmentioning

confidence: 99%

Effect of personalised, mobile‐accessible discharge instructions for patients leaving the emergency department: A randomised controlled trial

Doyle

Rippey

Jacques

et al. 2020

Emerg Medicine Australasia

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Objective: This pilot study assessed the efficacy of personalised, printed and mobile-accessible discharge instructions for pain relief for patients discharged from the ED. Methods: Patients presenting with pain caused by acute musculoskeletal or visceral complaints not requiring admission were eligible. Both groups received usual pain relief discharge advice, the intervention group received additional personalised printed and mobile-accessible discharge instructions. Numerical Rating Scale pain scores were measured at ED visit. Pain scores, Patient Global Impression of Change scale improvement scores, satisfaction with instructions, recall of pain relief advice, receipt of side effects advice and unscheduled visits were measured at 5 days. Results: A total of 80 patients, recruited over 14 days, were randomly allocated to the intervention or control group. Two patients were excluded and 81% (n = 65) were followed up at 5 days. There was no significant difference in change of pain scores or improvement scores between groups from visit to 5 day follow up. The intervention group showed significantly higher odds of being 'very satisfied' compared to the control group (odds ratio [OR] 7.14, 95% confidence interval [CI] 1.18-50.00), significantly higher odds of full recall of pain relief medication advice (OR 20.00, 95% CI 1.56-100.00) and significantly higher odds of receiving information on medication side effects (OR 6.25, 95% CI 1.67-20.00). Conclusions: Patients who received personalised printed and mobileaccessible ED discharge instructions for pain relief reported higher levels of satisfaction with their instructions, had better recall of their pain relief medications advice and received more information on medication side-effects.

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Patient Discharge Instructions in the Emergency Department and Their Effects on Comprehension and Recall of Discharge Instructions: A Systematic Review and Meta-analysis

Cited by 100 publications

References 66 publications

Using decision aids to support self-isolation during the COVID-19 pandemic

Using decision aids to support self-isolation during the COVID-19 pandemic

Quality of acute internal medicine: A patient-centered approach. Validation and usage of the Patient Reported Measure-acute care in the Netherlands

Effect of personalised, mobile‐accessible discharge instructions for patients leaving the emergency department: A randomised controlled trial

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