Pediatric emergency medicine trisk 4588 4588
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CHAPTER 133 ■ INSTRUCTIONS FOR
PARENTS
HILARY A. HEWES, NANETTE C. DUDLEY
DISCHARGE INSTRUCTIONS
Discharge instructions are an integral part of the emergency department
(ED) experience. Well-designed instructions serve as a summary of the ED
course and a reference for ongoing medical management by the patient and
outpatient care provider. In addition, review of instructions at discharge
offers a final opportunity for a patient to clarify any questions or concerns
about care received or the follow-up plan. Information given to the patient
and family needs to be provided in an understandable and retainable
manner. Lack of comprehension of discharge instructions may lead to
problems with compliance, incorrect use of medication, inadequate
treatment and follow-up, and ultimately negative patient outcomes.
LEGAL AND REGULATORY CONSIDERATIONS
The Centers for Medicare and Medicaid Services (CMS) measures specific
elements in the transition record at hospital discharge. Although obviously
not specific to ED care, these recommendations can be adapted to ED
discharge instruction content:
1. Discharge diagnosis
2. Procedures and tests performed, with significant findings, and any pending
tests
3. Medications prescribed/changes to medications, reasons for medication
4. Patient and family instructions
5. Reasons to follow up with primary care provider or specialist and reasons
to return to the ED
6. Follow up physician’s name, specialty, and contact information
Meaningful Use
Beginning in 2011, the CMS initiated a voluntary financial incentive plan
for the “meaningful use” of certified electronic health record technology by
