124 Resident Physician Awareness of Barriers to Post-Discharge Care From the Emergency Department

Document Type

Conference Proceeding

Publication Date

9-1-2025

Publication Title

Ann Emerg Med

Abstract

Study Objective: Physician awareness of barriers to safe and effective transitions of care following emergency department (ED) discharge is crucial. Limited data exists evaluating the rates of resident physician awareness of these barriers. Our objective was to quantify this level of awareness in comparison to their patient’s reality. Methods: We performed a secondary analysis of a prospective convenience sample of patients ≥18 years old at a single urban safety-net hospital with an EM residency program between 10/2024 and 1/2025. Barriers assessed included transportation difficulty, difficulty affording medications, need for assistance with activities of daily living, and lack of a primary care physician. Low health literacy, risk for cognitive dysfunction, and patient understanding of discharge instructions were measured by use of the REALM-R, MiniCog, and scoring of recorded comprehension questionnaires, respectively. The discharging physician completed a brief written survey immediately after the patient was discharged. The primary outcome was physician detection of these patient reported barriers, reported as sensitivity (patients reporting barriers that are identified by physicians / all patients reporting the specific barrier). McNemar’s test and Cohen’s kappa statistics were utilized to evaluate patient-physician agreement. Results: The sample included 206 total patients [10 (5%) excluded for missing data] and 179 surveys completed by 36 different PGY 1-3 residents. Median patient age was 59 years; 48% female, and 87% black. Across all domains, patients reported barriers at a higher rate than physicians, including transportation difficulties (29.7% vs 22.2%), need for assistance with ADLs (26.1% vs 8.1%), difficulty affording medications (23.2% vs 5.6%), lack of a primary care physician (18.2% vs 8.7%), limited health literacy (60.4% vs 27.2%), cognitive dysfunction (46.5% of patients >=65 vs 12.7%), and poor understanding of discharge instructions (32.9% vs 3.0%). Sensitivity of resident identification was low across all barriers, with the highest for transportation difficulties (31.7%) and lowest for medication cost concerns (3.1%). Using McNamara’s test, there was significant disagreement between patient reports and resident identification. Residents consistently under-identified barriers to ED discharge across all domains, except for transportation difficulty. Conclusions: Emergency medicine residents often underrecognize critical social and functional barriers that impact patient care after ED discharge. Poor agreement between patient-reported and physician-identified challenges, particularly in health literacy, the presence of a primary care physician, and financial constraints, suggesting a need for enhanced training, systematic screening, and interdisciplinary collaboration. Addressing these gaps is essential to improving discharge safety and reducing preventable adverse outcomes for vulnerable patients. [Formula presented] Yes, authors have interests to disclose Disclosure: SAEM Foundation Joseph Miller Grant Support SAEM Foundation

Volume

86

Issue

3

First Page

S53

Last Page

S54

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