title: Patient understanding of emergency department discharge instructions: where are knowledge deficits greatest?
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Emergency Medicine , Northwestern University, Chicago, IL, USA. kirsten.g.engel@gmail.com
authors.forename: Kirsten G
authors.initials: KG
authors.lastname: Engel
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Buckley
authors.forename: Victoria E
authors.initials: VE
authors.lastname: Forth
authors.forename: Danielle M
authors.initials: DM
authors.lastname: McCarthy
authors.forename: Emily P
authors.initials: EP
authors.lastname: Ellison
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Schmidt
authors.forename: James G
authors.initials: JG
authors.lastname: Adams
mesh_terms: D000328:Adult; D016009:Chi-Square Distribution; D015331:Cohort Studies; D032882:Comprehension; D004522:Educational Status; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D007902:Length of Stay; D008297:Male; D011939:Mental Recall; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010351:Patient Discharge; D010353:Patient Education as Topic; D011446:Prospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric; D013997:Time Factors