By Brendan Furlong, MD, Chief of Service, Emergency Department, Georgetown University Hospital
A recent study suggests that more than 75 percent of patients do not understand important aspects of their medical condition when they leave the Emergency Department (ED). Roughly one third of patients fail to understand what to do at home after discharge from the hospital and nearly a quarter don’t know the symptoms that should prompt a return to the ED.
Dr. Brendan Furlong stresses the importance of clear and thorough patient discharge instructions.
Perhaps most striking, the study found that 80 percent of patients who did not understand aspects of their care and the instructions about what to do next thought they understood everything.
In the hustle and bustle of a busy ED, our staff must be vigilant to ensure that each patient understands the care he or she receives. We also must communicate with the next provider who will care for that patient. Often, the care provided in the ED is only one step in a longer process that leads to discharge or admission to the hospital.
The information we share with our patients and the physicians who care for them is essential to getting the results we all want: a healthy patient. By giving clear, logical written instructions, and repeating the information, we hope to make a connection and ensure our patients’ safety.
In most EDs, roughly 75 percent of all patients seen are discharged to home and not admitted to the hospital. When a patient is discharged, several important pieces of information need to be conveyed including:
- The diagnosis,
- The treatment recommendations, which may include new medications or changes in current medications,
- Routine follow-up plans or referrals, and
- Instructions about what symptoms warrant a return to the ED.
When a patient has trouble understanding his or her care instructions, it is important to engage a loved one directly in the discharge process.
A brief summary of test results and blood analysis is shared with the patient, including information about any test results that are still pending.
In the case of children or people not capable of understanding the information we provide, a responsible caregiver (a parent, an adult child of elderly patients) is engaged in this process directly. Our discharge instructions are also recorded in our confidential medical systems.
One concern we face today is how readily medical information is available online. We need everyone to be aware that relevant information you may find on the Web might differ from your specific discharge instructions. In these cases, be sure to contact your doctor to clarify your appropriate treatment.
The key is this: Your recovery process is a partnership between you and the caregivers involved. Patients or their loved ones should take the opportunity to ask questions before leaving the hospital. Your caregivers are here to help you get better. Take the time to understand the next steps that your physician has recommended.
Note: Study researchers from the University of Michigan interviewed 140 patients at two Michigan hospitals. The study was published in July 2008 in the Annals of Emergency Medicine, "Patient Comprehension of Emergency Department Care and Instructions: Are Patients Aware of When They Do Not Understand?"
