Thursday, July 31, 2008

Patients Leaving Hospital Do Not Get Proper Instructions for After-Care

When patients are discharged from the hospital, their recovery depends on carefully following the doctors' instructions for their post care at home. Yet a vast majority of patients don't fully understand what they are supposed to do, and most are not even aware of how much their understanding falls short.

Recently, clinicians at Northwestern University's Feinberg School of Medicine found that more than three-quarters of patients (78 percent) do not fully understand the care and discharge instructions they receive from the emergency department. In addition, 80 percent of the time, patients weren't aware they didn't get it.

"It's distressing," said Kirsten Engel, M.D., a clinical instructor and lead author of the paper, which was published online in the Annals of Emergency Medicine. "Patients who fail to follow discharge instructions may have a greater likelihood of complications after leaving the emergency department."

Hospital patients must understand their diagnosis, their care, and their discharge instructions, the paper says. It is disturbing that so many patients do not understand their post-Hospital care. This occurred recently for my wife, leaving the hospital after a colonoscopy. Hurried instructions were given her by a nurse as she was ushered out the door, but when we were at home later, we had no idea what those instructions had included.

In this case, researchers assessed 138 patients and 2 caretakers in four categories of comprehension: diagnosis and cause, emergency department care, post-emergency department care and return instructions. About half (51 percent) did not understand fully what they were told in two or more categories. More than one-third (34 percent) of the comprehension deficiencies involved patients' understanding of post-emergency department care, while 15 percent involved diagnosis and cause. Of those patients with comprehension difficulties, only 20 percent realized that their understanding was incomplete or inaccurate.

While this study was done on emergency care, as my wife and I have discovered, the same problem concerns hospital staff in other areas. After care is important . . . doctors and nurses need to be trained to provide this, and patients need to remember how important it is to get it right.



Anonymous said...

I taught post-op/discharge instructions quite a few years ago, when doctors and their offices were just starting to embrace computers, but not all.

There were only a handful of doctors that had pre-printed instructions for the most common surgeries/procedures. Most pre-printed handouts had a few blank lines to add personalized instructions per case.

Those were ideal, and covered many complications along with their signs/symptoms, and a number to call if they had questions.

Less ideal were the duplicate "carbon" style discharge instructions, with many open lines that the nurses had to fill in with their own handwriting (almost as bad as drs when we're rushed because we're also admitting a new post-op next door while we're discharging you). Worse was that the patient received the COPY instead of the top page, which was the chart copy, so it was harder to read when the patient was at home.

Ideally, as a patient, I prefer the computerized handouts that can be personalized for individual cases while on the pc, then printing it out. It's much easier to read because there's no handwriting, and it's not on a carbon copy. Also, the can change the text size for older readers.

Although it wasn't a rule, I tried to do my teaching when a family member was present, and suggest they place the discharge instructions on the fridge as soon as they get their family member settled, because almost everyone has concerns once they're home, and knowing where clearly written post-op instructions are (fridge) makes things much easier for everyone involved.

Dave Jensen said...

Thank you for publishing this great comment. I wish that everyone could go through your course on how important post-op instructions are!