Understanding discharge instruction is crucial to optimal healing but can be compromised in the hectic environment in the emergency room. Waisman, Siegal, CHemo et.al. (2003) completed a study in which the objective was to determine the parents understanding of ED discharge instruction and factors that may affect home care. …
A convenience sample was used of 287 patients. In this particular ER, full understanding was found in 72% of the parents that had children discharge from the ER. The results showed that overall, there was a fair understanding in this case while 20% still showed very little understanding post discharge. Supporting the results of that study but getting poorer results, Gilroy noted in a study done in 2009 that patients who are discharged from the emergency room have a difficult time remembering the instructions, especially those that are given about such things as wound care and medications. In a study performed in an emergency room, doing call back 1 week after discharge, 68% could not tell the call back nurse what the instructions that were given were.
In a study performed by the University of Michigan Health System (2008), it is noted that around the nation there are 115 million patients that visit the emergency room. Of those patients, 3/4 leave with an impression of what happened or what should happen next. Most ER care teams including University of Michigan would like to see much better than 75% remember what to do next. What they found to be even more upsetting was that 80% of those that understood what to do next were "pretty sure what to do". Northwestern Hospital of Chicago (2008), performed a similar study, reviewing making post ER calls over a 6 month period and collecting data from those calls. Researchers at Northwestern, led by Engel, reported more than 75% of ED patients interviewed after discharge had deficient comprehension or less than complete memory. Further 20% of the patients who had difficulty with comprehension felt they were having problems understanding what the doctor was telling them in the first place.
Isaacman, Pur4vis, and Gyuro (2001), performed a study in an attempt to determine whether standardized instructions enhance communication of discharge information. They had 197 parents of children with otitis media. They studied three different groups. The first group got verbal instructions, the second got standardized instructions, and the third group received verbal instructions plus a typed copy of what was said. Parents were questioned about prescribed medications prior to leaving ER and again 2 days later on the phone. When data was calculated the parents who received standard instructions, in all cases, showed much better understanding and retention of information given them in the ER.
Understanding of the importance of implementing discharge planning, Barnard & Chapman (2009), completed and reported on a study which was conducted to describe emergency department nurses understanding and experience of implementing strong discharge planning and discharge instructions from the ER. For purposes of data collection, nurses were interviewed in a semi-structured process. The study was a phenomenological qualitative approach. ER nurses showed a great deal of interest in updating this process in the ER. However, there are many barriers here. The ER must provide sufficient time per nurse, clear policies and standards of discharge and professional enhancement and commitment.
In Ireland Dunnion & Kelly (2005) looked at the discharge of older adults from the emergency room and the effects of discharge planning and instructions on discharge. They found that approximately 65% of patients above the age of 65 went home without a complete picture of what was to happen next and because of this made medication errors and often did not see follow up when necessary. They had two groups in which patients were assigned randomly. Patients in group one were discharged using the nurses usual method and the other had a discharge management team. This tam ...
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