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La Comprensión del Paciente de las Recomendaciones al Alta del Servicio de Urgencias: ¿Cuáles son los Mayores Déficits de Conocimiento?
Author(s) -
Engel Kirsten G.,
Buckley Barbara A.,
Forth Victoria E.,
McCarthy Danielle M.,
Ellison Emily P.,
Schmidt Michael J.,
Adams James G.
Publication year - 2012
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/j.1553-2712.2012.01425.x
Subject(s) - medicine , emergency department , medical emergency , patient discharge , emergency medicine , medline , nursing , political science , law
ACADEMIC EMERGENCY MEDICINE 2012; 19:1035–1044 © 2012 by the Society for Academic Emergency Medicine Abstract Objectives: Many patients are discharged from the emergency department (ED) with an incomplete understanding of the information needed to safely care for themselves at home. Patients have demonstrated particular difficulty in understanding post‐ED care instructions (including medications, home care, and follow‐up). The objective of this study was to further characterize these deficits and identify gaps in knowledge that may place the patient at risk for complications or poor outcomes. Methods: This was a prospective cohort, phone interview–based study of 159 adult English‐speaking patients within 24 to 36 hours of ED discharge. Patient knowledge was assessed for five diagnoses (ankle sprain, back pain, head injury, kidney stone, and laceration) across the following five domains: diagnosis, medications, home care, follow‐up, and return instructions. Knowledge was determined based on the concordance between direct patient recall and diagnosis‐specific discharge instructions combined with chart review. Two authors scored each case independently and discussed discrepancies before providing a final score for each domain (no, minimal, partial, or complete comprehension). Descriptive statistics were used for the analyses. Results: The study population was 50% female with a median age of 41 years (interquartile range [IQR] = 29 to 53 years). Knowledge deficits were demonstrated by the majority of patients in the domain of home care instructions (80%) and return instructions (79%). Less frequent deficits were found for the domains of follow‐up (39%), medications (22%), and diagnosis (14%). Minimal or no understanding in at least one domain was demonstrated by greater than two‐thirds of patients and was found in 40% of cases for home care and 51% for return instructions. These deficits occurred less frequently for domains of follow‐up (18%), diagnosis (3%), and medications (3%). Conclusions: Patients demonstrate the most frequent knowledge deficits for home care and return instructions, raising significant concerns for adherence and outcomes.