Evaluation of Patient Understanding of Emergency Department Discharge Instructions

Document Type

Conference Proceeding

Publication Date

5-13-2025

Publication Title

Acad Emerg Med

Keywords

adult, audio recording, cognitive defect, conference abstract, controlled study, disease course, drug therapy, emergency ward, female, follow up, health literacy, human, major clinical study, male, questionnaire, race, sample size

Abstract

Background and Objectives: Patient understanding of discharge instructions is critical to ensure safe and effective transitions of care after ED discharge. Our objectives were to evaluate rates of comprehension of discharge instructions, identify domains with the lowest comprehension, and to determine patient factors associated with poor comprehension of discharge instructions. Methods: We performed a prospective IRB-approved study with a convenience sample of adults age ≥18 cared for by EM residents and discharged home from an urban ED. The primary outcome was the percent of complete understanding of essential discharge components, captured by audio recording of questionnaires administered to patients at the time of ED discharge. A single abstractor scored patient comprehension from audio-recordings (2 blinded abstractors to score at study conclusion). Descriptive statistics and univariate analyses are reported. Results: Of 90 total patients, median age was 59, 87% black, 48% female, 56% with low health literacy (REALM-SF < 7), 48% with an area deprivation index (ADI) ≥90th national percentile, 21% college graduates, 82% had a PCP, 54% of adults ≥65 with possible cognitive impairment (Mini-Cog < 3). Overall, 74% of patients reported receiving discharge instructions from their physician. Patients had a median comprehension score of all applicable subjects of 40% (IQR 19%-59%). Topics with the highest complete comprehension included follow-up provider (62%) and time (53%), purpose of medication prescribed (60%), and diagnosis (52%). Topics with the lowest complete comprehension were lab (10%) and imaging (14%) abnormalities, expected illness course (13%), non-pharmacologic treatments (12%), return precautions (18%), and name of newly prescribed medication(s) (30%). In univariate analyses, predictors of comprehension scores < 25th percentile included less than college education (OR 8.08, 1.01-64.40), low health literacy (OR 2.92, 1.03- 8.31), and male gender (OR 2.8, 1.03-7.42) [age, race, ADI, Mini-cog were not]. Conclusion: A substantial portion of patients discharged from our ED lacked understanding of essential discharge instructions, with low health literacy and low education being the greatest predictors. This study is limited by a small sample size and limited generalizability. Further work is needed to develop interventions that promote safe transitions of care after ED discharge.

Volume

32

Issue

S1

First Page

48

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