"Sign right here and you're good to go": a content analysis of audiotaped emergency department discharge instructions.

Abstract

The goal of this study is to quantitatively and qualitatively assess the quality and content of verbal discharge instructions at 2 emergency departments (EDs). This was a secondary data analysis of 844 ED audiotapes collected during a study of patient-emergency provider communication at 1 urban and 1 suburban ED. ED visits of nonemergency adult female patients were recorded with a digital audiotape. Of 844 recorded ED visits, 477 (57%) audiotapes captured audible discharge instructions suitable for analysis. Audiotapes were double coded for the following discharge content: (1) explanation of illness, (2) expected course, (3) self-care, (4) medication instructions, (5) symptoms prompting return to the ED, (6) time-specified for follow-up visit, (7) follow-up care instructions, (8) opportunities for questions, and (9) patient confirmation of understanding. Analysis included descriptive statistics, χ(2) tests, 2-sample t tests, and logistic regression models. Four hundred seventy-seven of 871 (55%) patient tapes contained audible discharge instructions. The majority of discharges were conducted by the primary provider (emergency physician or nurse practitioner). Ninety-one percent of discharges included some opportunity to ask questions, although most of these were minimal. Only 22% of providers confirmed patients' understanding of instructions. Verbal ED discharge instructions are often incomplete, and most patients are given only minimal opportunities to ask questions or confirm understanding.