The majority of patients do not understand their discharge instructions after leaving the emergency room:
The study, published online in July by the Annals of Emergency Medicine, found that 78 percent of patients did not understand at least one area and about half did not understand two or more areas. The greatest confusion surrounded home care “” instructions about things like medications, rest, wound care and when to have a follow-up visit with a doctor.
There are several reasons for this, including the pressure hospitals place on doctors to see more patients, poor physician communication skills, and low patient health literacy.
However, as the NY Times is wont to do, the piece takes a perspective without considering the physician’s point of view.
Each of the proposed solutions, such as dual-discharge by the nurse and doctor, and the “teach back” approach, take time. Time unfortunately, is at a shortage in the emergency setting, as EDs become more overcrowded and patients becoming less satisfied with their care. Unhappy patients can punish doctors via patient satisfaction surveys.
Combined with Medicare is punishing hospitals for high readmission rates, doctors are placed in a difficult position with pressures to maximize the number of patients seen, keeping waiting times low and patient satisfaction scores high, and spending more time at discharge.
So the solution of simply “explaining instructions better” is superficial and as always, easier said than done.
Related posts:
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- The Z-pack and a smooth discharge
- cc: "I want better discharge instructions"
- When patients extort hospitals
{ 2 comments }
Kevin, you are right on point with your comments.
This article is another example of poor reporting.
They interview a bunch of non-emergency physicians who make statements about what the emergency department should be doing differently.
Dr. Eric Coleman is a geriatrician without a lick of ED patient management experience. Yet he feels qualified to recommend that EDs make follow up calls to all patients after they leave and to state that hospitals need to “have some accountability for the no-care zone, the period between when you leave the emergency department or hospital and when you get into your primary care setting.”
News flash, CheeseBall … get them into your practice on the next day and there wouldn’t be that problem, would there? You can spend all the time you want going over their medications while the ED staff tries to worry about keeping patients from dying.
Yeah, difficult to squeeze more patient time out of these encounters. Some health plans have had success with placing case managers in the ER to review discharge instructions or at least follow up the next day to make sure the care plan is understood/followed. Readmissions due to misunderstandings are common, dangerous and expensive.
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