Obtaining Patient Input: Developing Emergency Department Discharge Instructions

2.50
Hdl Handle:
http://hdl.handle.net/10755/198308
Title:
Obtaining Patient Input: Developing Emergency Department Discharge Instructions
Abstract:
[ENA Annual Conference 2011 - Research Presentation] Obtaining Patient Input: Developing Emergency Department Discharge Instructions

Purpose: Previous research indicates that patients have difficulty understanding discharge instructions and these findings have important implications for adherence and outcomes. The objective of this study was to obtain patient guidance in the development of discharge instructions for five common emergency department (ED) diagnoses. Patient input can help improve the clarity and utility of ED discharge instructions in order to enhance understanding. ED patients without a clear understanding of their discharge instructions can lead to serious complications and the need for repeat ED visits or hospitalizations.

Design: Qualitative research methods were used to conduct the project. Five focus groups were conducted.

Setting: Focus groups were conducted at a federally qualified healthcare clinic (FQHC) in an
underserved area of Chicago.

Participants: English speaking patients > 18 were eligible for participation.

Methods: An extensive literature review was conducted, input from ED providers, subspecialists, health literacy and communication experts was solicited, and discharge instructions were then created for five common ED diagnoses: ankle sprain, back pain, head injury, laceration and kidney stones. At the beginning of each focus group, each patient completed a demographic information survey and a Rapid Estimate of Adult Literacy in Medicine (REALM).The REALM is a widely used instrument to measure literacy; scores range from 0 to 66 (low to high). During each of the one hour focus groups, participants reviewed discharge instructions for one of the chosen diagnoses. Participants were asked to provide input into the content, organization and presentation of the documents. The sessions were audio- and video-taped and researchers took notes on general feedback and specific suggested revisions. Using qualitative techniques, content analysis was performed to code for emergent themes across all five diagnoses.

Results/Outcomes: Fourteen patients participated, 57% female, mean age of 32 (SD 14.40). The mean REALM score was 57.3 (SD 16.74), indicating a 7th to 8th grade reading level. Several themes were identified from the focus groups. Themes and resulting modifications included defining complex words and concepts (simple words or definitions added to clarify complex words and concepts), presenting contextual framework (motivational information added to indicate the benefit of following instructions), providing practical information (specific everyday examples added to set guidelines for activities and care), clarifying uncertainty/managing expectations (statements added to acknowledge variability in patient recovery), and using visual aids and pictographs (pictures were added to help patients understand difficult concepts).

Implications: Patient input provides meaningful guidance in the development of diagnosis-specific discharge instructions. Several themes and patterns are identified with broad significance for the design of ED discharge instructions. Ultimately, the development of enhanced discharge documents will need to be guided by assessments of their impact on patient comprehension and outcomes.

Repository Posting Date:
21-Dec-2011
Date of Publication:
21-Dec-2011

Full metadata record

DC FieldValue Language
dc.titleObtaining Patient Input: Developing Emergency Department Discharge Instructionsen_GB
dc.identifier.urihttp://hdl.handle.net/10755/198308-
dc.description.abstract[ENA Annual Conference 2011 - Research Presentation] Obtaining Patient Input: Developing Emergency Department Discharge Instructions <br/><br/>Purpose: Previous research indicates that patients have difficulty understanding discharge instructions and these findings have important implications for adherence and outcomes. The objective of this study was to obtain patient guidance in the development of discharge instructions for five common emergency department (ED) diagnoses. Patient input can help improve the clarity and utility of ED discharge instructions in order to enhance understanding. ED patients without a clear understanding of their discharge instructions can lead to serious complications and the need for repeat ED visits or hospitalizations. <br/><br/>Design: Qualitative research methods were used to conduct the project. Five focus groups were conducted.<br/><br/>Setting: Focus groups were conducted at a federally qualified healthcare clinic (FQHC) in an <br/>underserved area of Chicago. <br/><br/>Participants: English speaking patients > 18 were eligible for participation. <br/><br/>Methods: An extensive literature review was conducted, input from ED providers, subspecialists, health literacy and communication experts was solicited, and discharge instructions were then created for five common ED diagnoses: ankle sprain, back pain, head injury, laceration and kidney stones. At the beginning of each focus group, each patient completed a demographic information survey and a Rapid Estimate of Adult Literacy in Medicine (REALM).The REALM is a widely used instrument to measure literacy; scores range from 0 to 66 (low to high). During each of the one hour focus groups, participants reviewed discharge instructions for one of the chosen diagnoses. Participants were asked to provide input into the content, organization and presentation of the documents. The sessions were audio- and video-taped and researchers took notes on general feedback and specific suggested revisions. Using qualitative techniques, content analysis was performed to code for emergent themes across all five diagnoses. <br/><br/>Results/Outcomes: Fourteen patients participated, 57% female, mean age of 32 (SD 14.40). The mean REALM score was 57.3 (SD 16.74), indicating a 7th to 8th grade reading level. Several themes were identified from the focus groups. Themes and resulting modifications included defining complex words and concepts (simple words or definitions added to clarify complex words and concepts), presenting contextual framework (motivational information added to indicate the benefit of following instructions), providing practical information (specific everyday examples added to set guidelines for activities and care), clarifying uncertainty/managing expectations (statements added to acknowledge variability in patient recovery), and using visual aids and pictographs (pictures were added to help patients understand difficult concepts). <br/><br/>Implications: Patient input provides meaningful guidance in the development of diagnosis-specific discharge instructions. Several themes and patterns are identified with broad significance for the design of ED discharge instructions. Ultimately, the development of enhanced discharge documents will need to be guided by assessments of their impact on patient comprehension and outcomes. <br/><br/>en_GB
dc.date.available2011-12-21T12:45:46Z-
dc.date.issued2011-12-21T12:45:46Z-
dc.date.accessioned2011-12-21T12:45:46Z-
All Items in this repository are protected by copyright, with all rights reserved, unless otherwise indicated.