Discharge Communication in Patients Presenting to the Emergency Department With Chest Pain: Defining the Ideal Content.
In an emergency department (ED), discharge communication represents a crucial step in medical care. In theory, it fosters patient satisfaction and adherence to medication, reduces anxiety, and ultimately promotes better outcomes. In practice, little is known about the extent to which patients receiving discharge information understand their medical condition and are able to memorize and retrieve instructions. Even less is known about the ideal content of these instructions. Focusing on patients with chest pain, we systematically assessed physicians' and patients' informational preferences and created a memory aid to support both the provision of information (physicians) and its retrieval (patients). In an iterative process, physicians of different specialties (N = 47) first chose which of 81 items to include in an ED discharge communication for patients with acute chest pain. A condensed list of 34 items was then presented to 51 such patients to gauge patients' preferences. Patients' and physicians' ratings of importance converged in 32 of the 34 items. Finally, three experts grouped the 34 items into five categories: (1) information on diagnosis; (2) follow-up suggestions; (3) advice on self-care; (4) red flags; and (5) complete treatment, from which we generated the mnemonic acronym "InFARcT." Defining and structuring the content of discharge information seems especially important for ED physicians and patients, as stress and time constraints jeopardize effective communication in this context. Chest pain accounts for up to 10% of all patient presentations in emergency departments (EDs) (Konkelberg & Esterman, 2003). The majority of these patients will usually be discharged within hours, after exclusion of serious conditions such as myocardial infarction (Goodacre et al., 2011). A comprehensive workup of low- to intermediate-risk patients is not feasible in the ED (Reichlin et al., 2009). Yet many of these patients go on to suffer from repeated episodes of chest pain, associated with anxiety and uncertainty about diagnosis and outcome (Jones & Mountain, 2009). Effective discharge communication, empowering patients to understand and memorize medical information, should therefore be an integral part of patient care. It is a likely contributor to better outcomes (Bishop, Barlow, Hartley, & William, 1997; Kessels, 2003), higher patient satisfaction (Kessels, 2003), better adherence to medication (Cameron, 1996; Kessels, 2003), more adequate disease management, and reduced anxiety (Galloway et al., 1997; Mossman, Boudioni, & Slevin, 1999).
a Department of Psychology , University of Basel.|b Department of Emergency Medicine , University Hospital , Basel.
Selina
S
Ackermann
b Department of Emergency Medicine , University Hospital , Basel.
Anette
A
Heierle
c Department of Psychosomatic Medicine , University Hospital , Basel.
Martina-Barbara
MB
Bingisser
d Center for Adaptive Rationality , Max Planck Institute for Human Development.
Ralph
R
Hertwig
b Department of Emergency Medicine , University Hospital , Basel.
Rakesh
R
Padiyath
b Department of Emergency Medicine , University Hospital , Basel.
Christian Hans
CH
Nickel
c Department of Psychosomatic Medicine , University Hospital , Basel.
Wolf
W
Langewitz
b Department of Emergency Medicine , University Hospital , Basel.
Roland
R
Bingisser
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002637:Chest Pain / Q000523:psychology* / Q000628:therapy*; D004636:Emergency Service, Hospital; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D063886:Patient Discharge Summaries / Q000592:standards*; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D012648:Self Care / Q000379:methods; D013557:Switzerland; D055815:Young Adult