Abstract
Patients who do not have enough information about their discharge plans have decreased treatment compliance, decreased patient safety, increased emergency department (ED) recidivism, and poor satisfaction. This project aimed to develop and implement a method to assess and improve patient understanding of treatment and discharge plan in the ED. The authors developed a questionnaire to assess patient knowledge using Centers for Medicare and Medicaid Services and Joint Commission recommendations, areas of communication deficits reported in other manuscripts, and ED staff and provider input. Responses from patient interviews were then scored against the medical record. Three trained scorers graded all responses, and inter-rater reliability was calculated using the kappa statistic.Baseline observations found that written discharge instructions were long and tedious, and important information was difficult to find. Based on initial patient scores, stakeholder interviews, and fishbone diagrams, the team developed a one-page simplified information page (SIP) targeted to inform patients their most relevant discharge instructions. Next, the SIP was tested on 118 patients to measure its effect on patient understanding. At the baseline study, no patients had complete understanding of their discharge instructions. The areas of lowest scores were medication instructions and indications to return to the ED. Implementation of the SIP resulted in statistically significant changes in score distribution across all questions assessed with the Wilcoxon signed-rank test. Interrater reliability between scorers was high (kappa=0.84). We incorporated the concept of the SIP to the cover page of our standard discharge instructions.Healthcare providers often spend valuable time educating their patients, and it is important to assess the effectiveness of this teaching to identify areas in which we may improve health literacy and patient understanding. This project has shown that a simple, easy-to-read, concise page developed with patient input significantly improved ED discharge instruction knowledge.
Subject
Public Health, Environmental and Occupational Health,Health Policy,Leadership and Management
Reference21 articles.
1. Patient comprehension of emergency department care and instructions: are patients aware of when they do not understand?;Engel;Ann Emerg Med,2009
2. Patient Input into the Development and Enhancement of ED Discharge Instructions: A Focus Group Study
3. Patient comprehension of discharge instructions from the emergency department: a literature review;Alberti;J Am Assoc Nurse Pract,2013
4. Office of Disease Prevention and Health Promotion, US Department of Health and Human Services . National action plan to improve health literacy. Washington, DC, 2010.
5. Literacy for health information of adult patients and caregivers in a rural emergency department;Hayes;Clin Excell Nurse Pract,2000
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