title: Mind the (knowledge) gap: the effect of a communication instrument on emergency department patients' comprehension of and satisfaction with care.
abstract: OBJECTIVE
  We developed a communication instrument to be used in the Emergency Department (ED) and hypothesized that use of this guide would increase patient comprehension of and satisfaction with care.
  
  
  METHODS
  This multi-site trial enrolled 643 patients in treatment and control groups. Comprehension of care was assessed by chart review and satisfaction measured via validated survey.
  
  
  RESULTS
  Use of the instrument was not associated with improvements in patient knowledge about their care, with a mean of 4.6 (95% CI: 4.8-5.8) comprehension defects in the control group and 4.4 (95% CI: 3.9-4.9) in the treatment group. There was no significant effect on patient satisfaction 76.4% versus 76.9%, p=0.34. Elderly patients in both groups were found to have 1.1 (p<0.01) more knowledge gaps than younger patients.
  
  
  CONCLUSIONS
  Patients frequently misunderstand medical care in the ED. Comprehension decreases with increasing age. An isolated communication instrument does not improve satisfaction with or understanding of the care received.
  
  
  CONCLUSIONS
  Providing a structured place for providers and patients to record details of care does not seem to improve satisfaction with or comprehension of care. Interventions that focus on communication skills and face time with patients may prove more effective.
authors.affiliation: St. Joseph Mercy Hospital, Department of Emergency Medicine, Ann Arbor, USA. Electronic address: ssimmons@epmg.com.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Simmons
authors.affiliation: University of Wisconsin Hospital, Division of Emergency Medicine, Madison, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Sharp
authors.affiliation: St. Joseph Mercy Hospital, Department of Emergency Medicine, Ann Arbor, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Fowler
authors.affiliation: St. Mary Mercy Hospital, Department of Emergency Medicine, Livonia, USA.
authors.forename: Hope
authors.initials: H
authors.lastname: Fowkes
authors.affiliation: St. Mary Mercy Hospital, Department of Emergency Medicine, Livonia, USA.
authors.forename: Patricia
authors.initials: P
authors.lastname: Paz-Arabo
authors.affiliation: MSN Southern Ohio Medical Center, Department of Emergency Medicine, Portsmouth, USA.
authors.forename: Mary Kate
authors.initials: MK
authors.lastname: Dilt-Skaggs
authors.affiliation: St. Joseph Mercy Hospital, Department of Emergency Medicine, Ann Arbor, USA.
authors.forename: Bonita
authors.initials: B
authors.lastname: Singal
authors.affiliation: DO Southern Ohio Medical Center, Department of Emergency Medicine, Portsmouth, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Carter
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003142:Communication; D032882:Comprehension; D004636:Emergency Service, Hospital; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D008824:Michigan; D008875:Middle Aged; D009820:Ohio; D010353:Patient Education as Topic / Q000379:methods*; D017060:Patient Satisfaction; D010549:Personal Satisfaction
keywords: Patient education; Patient satisfaction; Patient–HCP communication