Pediatric emergency medicine trisk 4595 4595
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normal medication regimen should also be noted. The Joint Commission
requires a complete, reconciled list of the patient’s medications provided
directly to the patient/guardian. All newly prescribed medications should be
listed on the hospital discharge instruction form in addition to including
directions to continue, modify, or discontinue previously prescribed
medications.
FOLLOW-UP
Compliance with outpatient physician follow-up is improved if an
appointment is made prior to discharge from the ED. It is helpful to provide
phone numbers for primary care physicians (especially for patients who do
not have a primary physician) and for subspecialists. Discharge instructions
can reinforce the importance of follow-up with the patient’s medical home,
and encourage families to coordinate their follow-up care with their primary
provider.
SUMMARY
Discharge instructions are an integral part of the ED experience and are
crucial for optimal continued care of the acute medical condition. Many
patients/guardians do not fully comprehend discharge instructions,
especially those with low literacy skills or low health literacy. Discharge
instructions should be reviewed orally by the primary practitioner or nurse
who cared for the patient. The person providing instructions should provide
an opportunity for the patient/guardian to clarify any remaining questions
concerning care prior to discharge. Well-designed discharge instructions
should be concise, with organized structure, including visual cues to
enhance recall, and should be presented verbally with a summary written
component. Both verbal and written instructions should be provided in the
patient/guardian’s native language when possible, and should be written at
or below a 6th grade level using lay medical terms. They should review the
key components to discharge, including patient diagnosis, anticipated length
of illness, home care, and return precautions, and should include
information about newly prescribed medications and changes to prior
medication regimens. The understanding of and receipt of the instructions
should be confirmed by one of the main care providers. The use of
technology will continue to expand the options for delivery of discharge
