Pediatric emergency medicine trisk 4592 4592
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care. Multimedia instruction also offers other advantages over traditional
instruction, including the capability for asynchronous learning,
customizable interactive content based on the needs of the patient and
family, multimedia presentation to overcome literacy or language barriers,
and optimization of content and presentation based on feedback using web
diagnostics. Other approaches, such as text messaging patients and families
after ED discharge, have been associated with increased compliance with
medications, and follow-up. Adolescent patients may even prefer receiving
discharge instructions by email or text along with printed instructions.
Combination Method: The Preferred Method
Optimal discharge instructions combine written and verbal instructions and
include pictures when relevant. Including pictures as visual cues can help to
improve recall. Drawing pictures demonstrating the correct dosing of
pediatric suspension medications may be particularly important. The
addition of verbal reinforcement, especially in the patient/guardian’s
preferred language, may further solidify understanding of the information,
while at the same time satisfying the family’s desire to have a final
interaction with their care provider. The provision of discharge instructions
needs to be a two-way conversation, allowing the family to ask questions,
and engaging them with methods such as Ask Me 3 or TeachBack that
enhance and assess their understanding.
OBSTACLES TO COMPREHENSION AND RETENTION OF
DISCHARGE INSTRUCTIONS
There are several obstacles to effective discharge instruction. Up to half of
patients receiving discharge instructions were not aware they had, in fact,
received them. Patients/parents may not even read the discharge instructions
provided. Often the medical provider does not review all key components
of discharge instructions. Even after review with a medical provider, there
is variable retention of that material, and many families leaving the ED are
unable to fully recall discharge information.
Engel et al. evaluated patient understanding of discharge instructions
across five domains: diagnosis, medications, home care, follow-up, and
return instructions. Two-thirds of discharged patients showed minimal or no
understanding in at least one of the domains evaluated, with a deficit of
