Pediatric emergency medicine trisk 4590 4590
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Studies of discharge after hospitalization have shown that patients prefer
verbal instructions from their care provider prior to discharge. Patients like
to have a final interaction with their care provider to clarify ongoing
treatment plans and to have a chance to ask remaining questions. Verbal
instructions may help to overcome literacy barriers to comprehension of
written instructions. However, verbal instructions alone are not adequate
because they rely on variable communication skills of providers. Verbal
instructions alone also do not provide any lasting documentation for the
patient to reference.
Written Instructions
Written materials may improve recall of discharge information. A written
record of the discharge instructions not only helps the patient, but also can
provide valuable information to follow-up practitioners as a reference for
diagnoses, care received, and changes in medications. To standardize the
information provided to patients/families, many centers have transitioned to
preformatted instructions that have the benefit of being easily legible and
may be more time efficient. However, information needs to be pediatric
specific and individualized. Ideally, written instructions should have
diagnosis-specific information structured under separate headings for each
diagnosis. Providers can highlight the most critical information. Written
instructions without verbal reinforcement are not adequate as they do not
give patients and families the chance to ask clarifying questions. There is
also a risk of discrepancy between reading comprehension level of the
patient/family and the level of the instructions (see below). If the
instructions are not written in the native language of the family, they will
not be well understood. Caution should be used to avoid including
superfluous information that can distract from the crucial information.
There is no consensus on the optimal person to provide discharge
instructions to families. Patients surveyed when leaving the inpatient units
of a hospital prefer their physician to review discharge instructions. Ideally,
one of the main care providers (MD, nurse practitioner, bedside nurse, etc.)
should review instructions with the patient and provide the option of further
clarification by his or her practitioner if necessary.
