06:29pm Tuesday 18 February 2020

Researchers say patients leave ER with poor understanding of how to care for themselves

While experts note that discharge education should begin with the initial assessment, it has often been an afterthought, leaving patients with unanswered questions and uncertainty about self-care.

Effective communication is an important part of quality care, especially in a distracting and time-limited environment like the ED.  In a new review article, researchers at The Hospital for Sick Children (SickKids) and Children’s Hospital Boston have found there is a lack of patient-family comprehension at the time of discharge from the ED. Patients and families are frequently unable to report the diagnosis, instructions for at-home care, medication use, or reasons to return to the hospital. The review article was published in the January issue of Annals of Emergency Medicine.

Researchers reviewed more than 50 studies from both adult and paediatric populations in MEDLINE and Cochrane databases, which contain journals from around the world. They summarized the current risks associated with insufficient communication at the time of discharge and also provide recommendations to improve patient and family comprehension.

“Discharge communication is an opportunity to recap the visit, teach patients and families how to safely care for themselves or their loved ones at home, and address any remaining questions,” says Dr. Stephen Porter, Principal Investigator of the review and Head of Emergency Medicine and Senior Associate Scientist in Child Health Evaluative Sciences at SickKids. “Failure to understand important elements of care can result in medical error at home and safety risks including incorrect medication use, inappropriate home care and failure to follow-up on concerning symptoms.”

Researchers recommend that instructions be given verbally, in writing and with visual representation to improve comprehension. Patients need structured content and clear instructions about at-home care with opportunities to ask questions, they say.

Porter explains that patients and families with limited understanding of health terms or language fluency are likely to be at a higher risk of leaving the ED with insufficient comprehension. “Poor understanding of instructions may also increase the risk of the patient revisiting the ED,” says Porter, who is also Associate Professor of Paediatrics at the University of Toronto. “It’s a two-way conversation that has often been overlooked. Language, appropriate reading level and use of medical terms need to be considered so that the conversation can be tailored to the patient.”

The researchers focused on studies that examined the content, delivery and comprehension of discharge instructions. They found in one study that although 76 per cent of the patients received an explanation of their symptoms, only 34 per cent received instructions about symptoms that should cause them to return to the ED. They also found that even when instructions were detailed and complete they can result in deficient comprehension if not presented in a way that is understandable to the patient or relative.

Another study included in the review found that while 72 per cent of patients could read the discharge instructions aloud, only 49 per cent could report the treatment plan back to the health-care provider.

“While improved communication at discharge from the ED is crucial for patient safety, future research should address the relationship between discharge process and outcomes, including preventable morbidity and mortality, and cost to the health-care system,” says Porter.

This review was supported by Program for Patient Safety and Quality at Children’s Hospital Boston, the Emergency Medicine Foundation, the Institute for International Emergency Medicine and Health, Brigham and Women’s Hospital Department of Emergency Medicine and SickKids Foundation.

About The Hospital for Sick Children
The Hospital for Sick Children (SickKids) is recognized as one of the world’s foremost paediatric health-care institutions and is Canada’s leading centre dedicated to advancing children’s health through the integration of patient care, research and education. Founded in 1875 and affiliated with the University of Toronto, SickKids is one of Canada’s most research-intensive hospitals and has generated discoveries that have helped children globally.  Its mission is to provide the best in complex and specialized family-centred care; pioneer scientific and clinical advancements; share expertise; foster an academic environment that nurtures health-care professionals; and champion an accessible, comprehensive and sustainable child health system.  SickKids is proud of its vision of Healthier Children. A Better World.™ For more information, please visit www.sickkids.ca

About SickKids Research & Learning Tower
SickKids Research & Learning Tower will bring together researchers from different scientific disciplines and a variety of clinical perspectives, to accelerate discoveries, new knowledge and their application to child health — a different concept from traditional research building designs.  The Tower will physically connect SickKids science, discovery and learning activities to its clinical operations.  Designed by award-winning architects Diamond + Schmitt Inc. and HDR Inc. with a goal to achieve LEED® Gold Certification for sustainable design, the Tower will create an architectural landmark as the eastern gateway to Toronto’s Discovery District.  SickKids Research & Learning Tower is funded by a grant from the Canada Foundation for Innovation and community support for the ongoing fundraising campaign. For more information, please visit www.buildsickkids.com.

For more information, please contact:

Matet Nebres
Manager, Media Relations
Communications and Public Affairs
The Hospital for Sick Children
Phone: 416-813-6380
Fax: 416-813-5328
email: matet.nebres@sickkids.ca

Caitlin McNamee-Lamb
Communications Specialist
Communications and Public Affairs
The Hospital for Sick Children
Phone: 416-813-7654 ext. 1436
Fax: 416-813-5328
email: caitlin.mcnamee-lamb@sickkids.ca

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