Pediatric emergency medicine trisk 4593 4593
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understanding in home care (40%) and return instructions (51%) occurring
most often. A study examining children with a return visit within 72 hours
of discharge from the ED found that 41% of caregivers were not instructed
on all key components of discharge, and almost half (47%) were not
educated on the likely duration of illness. Other studies have shown that
less than half of important discharge concepts (medication details, signs of
improvement vs. worsening condition) were recalled at exit interviews from
the ED. In addition, Engel found that although 78% of patients
demonstrated problems with comprehension, only 20% of patients
recognized their comprehension deficits. This suggests that multiple factors,
such as inadequate provision of instructions, and poor comprehension of
instructions create obstacles to effective discharge teaching.
LITERACY AND LANGUAGE COMPREHENSION
Compliance with discharge instructions and follow-up is closely tied to
comprehension of the instructions. Two of the greatest variables that
influence patient comprehension are reading ability and English language
comprehension. In 1992, the National Adult Literacy Survey evaluated the
condition of literacy in the United States. Almost one-fourth of U.S. adults
displayed skills in the lowest category of proficiency, with the average adult
in the United States reading between the 8th and 9th grade levels. This
study was repeated in 2003 with minimal change in average reading level.
Several studies examined average reading level of patients compared to
the average reading level required to comprehend discharge instructions.
The majority of these studies focused on the adult population, but as many
young children rely on their parent’s literacy level, these studies remain
pertinent to the pediatric population. Clarke found that 60% of patients read
below grade 7 level. Studies conducted in pediatric EDs show that although
most discharge instructions are written at a college reading level, almost
half of parents had a high school education or less. Considering the above,
discharge instructions should be written at or below 6th grade reading level
in order to optimize chances that the majority of patients/guardians will be
able to comprehend them. The use of medical jargon is particularly difficult
to comprehend and should be avoided.
It is important to note that reading literacy does not always translate to
functional health literacy. Health literacy is defined by the Institute of
