Doctors' orders lost in translation

July 17, 2008

When patients are discharged from the emergency department, 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 the chasm in their understanding.

A researcher at Northwestern University's Feinberg School of Medicine found more than three-quarters of patients (78 percent) do not fully understand the care and discharge instructions they receive in 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 of emergency medicine at the Feinberg School 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."

"It is critical that emergency patients understand their diagnosis, their care, and perhaps most important, their discharge instructions," said Engel, who also is a physician in the emergency medicine department at Northwestern Memorial Hospital. "It is disturbing that so many patients do not understand their post-emergency department care, and that they do not even recognize where the gaps in understanding are.

Researchers assessed 138 patients and 2 caretakers from Ann Arbor, Michigan 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.

"The bottom line is that we need better strategies for identifying patients who are having difficulty understanding their care and instructions in the emergency department," Engel said. "The chaotic nature of the emergency department environment poses significant challenges to communication. We can, however, strive to minimize communication failures by determining why they occur and how we may intervene to reduce or prevent them. This will be critical to improving patient care in the emergency department."

Patients can help themselves by asking emergency department staff to repeat or clarify points that remain unclear. When possible, patients may benefit by bringing a family member or friend with them to the emergency department who can ask questions and help remember the patient's post emergency department care instructions.

"When you are in the emergency department, be honest and don't be afraid to ask questions," Engel advised. "If you don't understand what the doctor has told you, keep asking questions until you do. That's what we're there for."

Source: Northwestern University