CanadiEM Frontline Primer

CanadiEM Frontline Primer – ED Skills – Safe Discharge

In Medical Concepts by Teresa ChanLeave a Comment

Points to Focus upon in Discussions

Verbal discharge instructions are important to provide to your patient, but especially during the time of COVID-19, they may be especially challenging.

  • Patients may be distracted, they may not have collateral visitors who can help them to remember things.
  • Patients who are hard of hearing often use visual cues to help them understand speech; with our PPE on, they may not be able to read your lips. Be patient and augment with written discharge instructions whenever possible.
The SERFAD Mnemonic
  • S – Symptomatic management
  • E – Educate
  • R – Reassure
  • F – Followup
  • A – Alarm signs
  • D – Document

A recent meta-analysis showed that verbal discharge instructions may not be sufficient​1​. Adding video or written feedback has still not been shown to increase efficacy in a statistically significant way.

What has improved outcomes is the TEACH BACK method, which was shown in one pre/post-intervention study to improve average percentage of discharge instruction recall by around 15% compared to baseline​2​.

Essential Elements of Written Discharge Instructions

Adapted from Taylor & Cameron​3​

  • Patient name
  • Physician name
  • Purpose of discharge instruction (Explain why you’re talking to the patient)
  • Diagnosis/expected course (Based on your diagnosis)
  • Potential complications (Tailored to specific presenting illness)
  • Patient instructions (Be specific or tailored, if possible)
  • New medication instructions
  • Follow-ups that are being set up (and contact information to close the loop). If there are specific dates and times already known for the appointments, then please write these down.

On the official chart, it is also good form to document the patient’s receipt of this summary, with specific dates/times.

Other things to consider
  • Written language literacy of patient
  • Visual acuity of patient for reading
  • Clarity of your writing (if you are handwriting) or the font size (if you are typing and printing)

Recommended Reading, Videos, and Podcasts

References

  1. 1.
    Hoek A, Anker S, van B, Burdorf A, Rood P, Haagsma J. Patient Discharge Instructions in the Emergency Department and Their Effects on Comprehension and Recall of Discharge Instructions: A Systematic Review and Meta-analysis. Ann Emerg Med. 2020;75(3):435-444. doi:10.1016/j.annemergmed.2019.06.008
  2. 2.
    Slater B, Huang Y, Dalawari P. The Impact of Teach-Back Method on Retention of Key Domains of Emergency Department Discharge Instructions. J Emerg Med. 2017;53(5):e59-e65. doi:10.1016/j.jemermed.2017.06.032
  3. 3.
    Taylor D, Cameron P. Discharge instructions for emergency department patients: what should we provide? J Accid Emerg Med. 2000;17(2):86-90. doi:10.1136/emj.17.2.86

The following is part of the CanadiEM Frontline Primer. An introduction to the primer can be found here. To return to the Primer content overview click here.

This post was copyedited and uploaded by Johnny Huang.

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Teresa Chan

Teresa Chan

Senior Editor at CanadiEM
Emergency Physician. Medical Educator. #FOAMed Supporter, Producer and Researcher. Chief Strategy Officer of CanadiEM. Associate Professor, Division of Emergency Medicine, Department of Medicine, McMaster University.
Teresa Chan
- 15 mins ago