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 sufficient1. 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 baseline2.
Essential Elements of Written Discharge Instructions
Adapted from Taylor & Cameron3
- 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
- EM Ottawa – We need to talk: Communicating with patients
- EM Docs – Maximizing the “Safe” Discharge (CAUTION American Resource)
- EM Cases – Effective Patient Counselling
- EMJ – Discharge instructions for emergency department patients: What should we provide?
- Annals of EM – Patient Discharge Instructions in the Emergency Department and Their Effects on Comprehension and Recall of Instructions: A Systematic Review and Meta-analysis
- The Journal of Emergency Medicine – The Impact of Teach-Back Method on Retention of Key Domains of Emergency Department Discharge Instructions
- 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.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.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.