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Health Services Research & Development

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2011 HSR&D National Meeting Abstract

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2011 National Meeting

3037 — Emergency Department Discharge Information: What is Provided and do Patients Understand?

Hastings SN (Durham COE & GRECC), Stechuchak KM (Durham COE), Schmader KE (Durham GRECC), Weinberger M (Durham COE), Tucker DC (Durham COE), Oddone EZ (Durham COE)

Objectives:
Discharge instructions are an important part of the care provided in the emergency department (ED); however, little is known about this care process. Our study sought to assess older veterans’ understanding of their ED discharge information and to describe printed ED discharge materials.

Methods:
Telephone interviews were conducted with 305 patients aged 65 or older (or their proxies) within 48-hours of discharge from a VAMC ED. Patients were asked about their understanding (at the time of ED discharge) of information in 5 domains: ED diagnosis, expected course of illness (i.e., how long symptoms or illness were expected to last), return precautions (i.e., symptoms that should prompt medical care), new medications, and follow-up care. Medical records, including ED discharge information sheets, were reviewed for additional information.

Results:
Patients had a mean age of 74.6 years; 2.3% were female, 30.5% were black, 23.9% lived alone, 42% reported their health as poor or fair, and 43.6% screened positive for low health literacy. Patients or their proxies reported not understanding information about their ED diagnosis (18.4%), expected course of illness (41.6%), return precautions (26.9%), possible side effects of new medications they were prescribed (30.3%), and how soon they needed to follow-up with their primary care provider (23.3%). Overall, 84.6% of patients had a provider-generated ED discharge information sheet in the medical record; however, only 57.4% of veterans reported receiving a paper with information about their health or medicines. ED discharge information sheets (n = 258) were missing information about ED diagnosis (88%), expected course of illness (96.9%), return precautions (42.6%), new medications, if prescribed (77.2%), and who to call if the patient’s condition worsened (41.9%). Considering aftercare sheets (pre-printed condition-specific information, n = 122) together with provider-generated ED discharge information sheets, 24.4% of printed ED discharge materials contained information in all applicable domains.

Implications:
Older veterans may not understand key pieces of information at the time ED discharge, and the information may also be missing from printed ED discharge materials.

Impacts:
Strategies are needed to improve communication of ED discharge information to older veterans and their families.


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