ER patients often don't grasp discharge orders

NEW YORK (Reuters Health) - Patients often fail to fully comprehend the treatment they receive during an emergency department visit or recall instructions for their care after they leave, new research suggests.

More often than not, these patients aren't even aware that they have not understood what transpired or remembered what they were told, the investigators note in their study, published in the Annals of Emergency Medicine.

To shed more light on the communication process that occurs in this setting, Dr. Kirsten G. Engel at Northwestern University in Chicago and colleagues interviewed 140 adult English-speaking patients or their primary caregivers after discharge from emergency departments at two teaching hospitals.

The subjects were asked questions about their diagnosis and the cause of their symptoms; the care they received, discharge recommendations and return instructions.

The results showed that 78 percent of patients or their caregivers had a deficient comprehension in at least one of the above areas and 51 percent had deficits in two or more areas.

At 34 percent, the highest rate of mistakes involved after-care, which raises significant concerns about patients' ability to adhere to discharge instructions and recommendations after leaving the ED," the investigators note.

"Moreover," they add, "our study suggests that we cannot simply ask patients to identify their comprehension deficiencies because the majority did not report difficulties in areas in which deficits were objectively demonstrated."

Specifically, subjects were unaware of their comprehension deficits 80 percent of the time.

Engel's group recommends that clinicians test their patients' understanding by asking them to repeat information in their own words. Improving the content and organization of written discharge instructions may also be of benefit.

SOURCE: Annals of Emergency Medicine, July 7, 2008 online.