Older Patients' Understanding of Emergency Department Discharge Information and Its Relationship With Adverse Outcomes : Journal of Patient Safety

Secondary Logo

Journal Logo

Advanced Search
Original Articles

Older Patients' Understanding of Emergency Department Discharge Information and Its Relationship With Adverse Outcomes

Hastings, Susan N. MD, MHS*†‡§; Barrett, Amanda MD∥; Weinberger, Morris PhD*¶; Oddone, Eugene Z. MD, MHS*; Ragsdale, Luna MD∥; Hocker, Michael MD∥; Schmader, Kenneth E. MD†‡§

Author Information

From the *Center for Health Services Research in Primary Care, and †Geriatrics Research, Education and Clinical Center, Veterans Affairs Medical Center, Durham, North Carolina; ‡Department of Medicine, Division of Geriatrics, §Center for the Study of Aging and Human Development, and ∥Department of Surgery, Division of Emergency Medicine, Duke University Medical Center, Durham, North Carolina; and ¶Department of Health Policy and Management, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina.

Correspondence: Susan N. Hastings, MD, MHS, Room 3502, Blue Zone, Duke South, Box 3003, Duke University Medical Center, Durham, NC 27710 (e-mail: [email protected]).

This research was conducted while Dr. Hastings was supported by a VA Health Services Research and Development Career Development Award (CD 06-019) and a Hartford Geriatrics Health Outcomes Scholar Award from the AGS Foundation for Health in Aging/John A. Hartford Foundation. Dr. Weinberger is a HSR&D Senior Career Scientist, Department of Veterans Affairs.

Portions of this work were presented at the 2009 Annual Scientific Meeting of the American Geriatrics Society in Chicago, IL. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.

Journal of Patient Safety 7(1):p 19-25, March 2011. | DOI: 10.1097/PTS.0b013e31820c7678

Abstract

Objectives: 

To describe older patients' understanding of emergency department (ED) discharge information and to explore the relationship between understanding of ED discharge information and adverse outcomes.

Methods: 

Telephone interviews were conducted with patients 65 years or older (or their proxies) within 72 hours of discharge from an academic medical center ED. We assessed 4 areas of discharge information: ED diagnosis, expected course of illness, self-care instructions, and return precautions. Adverse events were defined as repeat ED visits and hospitalizations or deaths within 90 days of ED discharge. Reverse Kaplan-Meier curves were constructed to illustrate cumulative event probabilities according to patient understanding of discharge information (differences examined with log-rank tests).

Results: 

Of 92 respondents (mean patient age, 75.1; SD, 7.4; 59.8% female subjects), patients or proxies reported not understanding discharge information about diagnosis (20.7%), self-care instructions (16.3%), expected course of illness (63%), and return precautions (55.7%). Within 90 days of ED discharge, 42.3% of patients had returned to the ED, 30.4% were hospitalized, and 4.3% had died. There was little difference in cumulative event probabilities according to whether patients understood self-care instructions or return precautions. Adverse event probabilities were higher among patients who did not understand their ED diagnosis (P = 0.33) and those who did not understand expected course of illness (P = 0.12), although these did not achieve statistical significance.

Conclusions: 

A substantial number of older patients, or proxies, may not understand ED discharge information, and this could have an effect on patient outcomes. Strategies are needed to improve communication of ED discharge information to older patients and their families.

© 2011 Lippincott Williams & Wilkins, Inc.

Full Text Access for Subscribers:

Not a Subscriber?

Buy
Request Permissions

You can read the full text of this article if you:

Access through Ovid