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