Discharged ER patients often miss instructions

CBC News

Posted: Jan 24, 2012 2:36 PM ET

Emergency department communication study

People who are discharged from emergency departments are often unable to tell what symptoms should raise alarms and make them return to the hospital, a review suggests.

Dr. Stephen Porter, head of emergency medicine at Toronto’s Hospital for Sick Children, led a review of more than 50 studies on the subject. The papers examined the content, delivery and comprehension of discharge instructions for both adults and children.

In the hectic and distracting environment of an emergency department, key instructions to patients can be lost. (Paul Chiasson/Canadian Press)

It’s important for doctors and nurses to communicate effectively with patients to deliver the best care. But in the hectic and distracting environment of an emergency department, those key instructions can be lost.

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Emergency department volume rises as office visits fall

The economy is blamed for driving patients to the ED and away from doctors’ offices. Visits went up a record 10% from 2008 to 2009.

By Emily Berry, amednews staff. Posted Jan. 16, 2012.

As the recession hit the U.S. in 2008 and 2009, more Americans, both uninsured and those with private health coverage, sought care in hospital emergency departments.

The most recent available estimates from the Centers for Disease Control and Prevention show a steep increase in visits to emergency departments and a rise in the percentage of emergency patients who were uninsured.

• In 2009, emergency department visits went up to 136 million from less than 124 million in 2008. That was nearly a 10% increase, the steepest single-year upsurge on record.
• Those 136 million visits worked out to 45.1 visits per 100 people, up from 41.4 per 100 in 2008 and 39.4 in 2007.
• Of the 136 million visits in 2009, 19% were uninsured patients and 39% were privately insured patients, compared with 15.4% and 41.9%, respectively, in 2008.
• In a poll by the American College of Emergency Physicians in March 2011, 80% of respondents said patient volume had increased “somewhat” or “significantly” during the previous year.

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With Discharge Instructions, Less is More

The trend of voluminous, exhaustive discharge instructions puts the pressure on patients to understand and identify complex risk factors, like infection. According to the research, this is probably a bad idea.

I think that good discharge instructions are a great idea. In fact, I often wonder why they are only given out after an ED visit. Wouldn’t discharge instructions be useful after a visit to a primary care physician or after a hospitalization? But you don’t seem to see them being used in these other settings. Regardless, discharge instructions are an integral part of an ED visit, which begs the question: Are they working?

A few thoughts before we dive into the literature to answer this question. First is the issue of quantity over quality. Some people seem to think that if discharge instructions are a good thing, then the more the better. Now everyone is using computerized instructions that create little medical textbooks for parents and patients to take home. For the visit of a febrile child with gastroenteritis, your computer can spit out multiple instruction sheets (of course, written at a 6th grade level and in large type) on how to treat fever, vomiting, diarrhea and how to take the medications you’ve prescribed.

These computer-generated instructions can be needlessly voluminous. Read more

The Standardized ED: Performance Metrics Improve ED Efficiency

Scheck, Anne