Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Talk to your patients before sending them home from the ED

Charles A. Pilcher, MD
Patient
August 26, 2011
Share
Tweet
Share

So you’re not having a heart attack like your wife thought. That’s the good news. But what is wrong, what did cause that pain, and what should you do from here on out?

That’s the purpose of discharge instructions, and it’s not enough for the ED staff to just print out some forms, say “sign here,” and send you on your way.

What constitutes good discharge instructions, and why are they critical in the decision to pursue or defend a malpractice case?

Annals of Emergency Medicine in April published a thorough study by Drs. Anita Vashi and Karin Rhodes on the quality of ED D/C instructions. They audio-taped 477 discharge encounters and evaluated them for content in 9 areas:

  • Explanation of illness
  • Expected course
  • Self-care
  • Medication instructions
  • Symptoms prompting return to the ED
  • Specific time for a follow-up visit
  • Instructions to seek follow-up care
  • Opportunity for questions
  • Confirmation of patient understanding

According to the authors’ assessment, discharge instructions on key elements of an emergency department visit were – at best – excellent 73% of the time and then in only one of nine areas. Instructions were less than excellent in as many as 98% of the charts in the area of “confirmation of patient understanding.” The “expected course of the disease” was adequately explained only 24% of the time.

Total time spent on the discharge process amounted to just under 4 minutes, meaning that (no surprise here) doctors spend more time charting than they do actually talking to patients.

On average, discharge instructions were present but less than excellent nearly 2/3 of the time. This means that these patients leave the Emergency Department with an incomplete understanding of the nature of their problem, what could happen, what to expect and what to do if the unexpected happens. Clearly there is room for improvement.

The authors suggest several solutions, such as the ED actually making a follow-up appointment for patients, dedicating a nurse to the discharge process, confirming the patient’s contact information at discharge, and making a follow-up phone call the following day to review the course of the illness and the instructions.

In the meantime, the message to Emergency Department physicians and nurses is “Talk to your patients before sending them home.”

“Sign right here and you’re good to go,” while a common approach, is not enough.

Charles A. Pilcher is an emergency physician who has helped both plaintiff and defense attorneys with malpractice litigation for over 25 years. He can be reached at his self-titled site, Charles A. Pilcher, MD.

Submit a guest post and be heard on social media’s leading physician voice.

Prev

How much physician guidance do patients want with medical decisions?

August 25, 2011 Kevin 4
…
Next

Hurricane tips that patients and health professionals should know

August 26, 2011 Kevin 1
…

ADVERTISEMENT

Tagged as: Emergency Medicine, Malpractice

Post navigation

< Previous Post
How much physician guidance do patients want with medical decisions?
Next Post >
Hurricane tips that patients and health professionals should know

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More by Charles A. Pilcher, MD

  • Teen dies when blood culture protocol botched: What can we learn from this tragedy?

    Charles A. Pilcher, MD
  • a desk with keyboard and ipad with the kevinmd logo

    tPA is the standard of care for stroke but with significant risks

    Charles A. Pilcher, MD
  • a desk with keyboard and ipad with the kevinmd logo

    How a doctor reviews cases for both plaintiff and defense attorneys

    Charles A. Pilcher, MD

More in Patient

  • AI’s role in streamlining colorectal cancer screening [PODCAST]

    The Podcast by KevinMD
  • There’s no one to drive your patient home

    Denise Reich
  • Dying is a selfish business

    Nancie Wiseman Attwater
  • A story of a good death

    Carol Ewig
  • We are warriors: doctors and patients

    Michele Luckenbaugh
  • Patient care is not a spectator sport

    Jim Sholler
  • Most Popular

  • Past Week

    • Why medical students are trading empathy for publications

      Vijay Rajput, MD | Education
    • Physician patriots: the forgotten founders who lit the torch of liberty

      Muhamad Aly Rifai, MD | Physician
    • The hidden cost of becoming a doctor: a South Asian perspective

      Momeina Aslam | Education
    • Why fixing health care’s data quality is crucial for AI success [PODCAST]

      Jay Anders, MD | Podcast
    • Closing the gap in respiratory care: How robotics can expand access in underserved communities

      Evgeny Ignatov, MD, RRT | Tech
    • Reclaiming trust in online health advice [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • How scales of justice saved a doctor-patient relationship

      Neil Baum, MD | Physician
    • A faster path to becoming a doctor is possible—here’s how

      Ankit Jain | Education
    • Make cognitive testing as routine as a blood pressure check

      Joshua Baker and James Jackson, PsyD | Conditions
    • How dismantling DEI endangers the future of medical care

      Shashank Madhu and Christian Tallo | Education
    • The broken health care system doesn’t have to break you

      Jessie Mahoney, MD | Physician
  • Recent Posts

    • Why fixing health care’s data quality is crucial for AI success [PODCAST]

      Jay Anders, MD | Podcast
    • Why so many physicians struggle to feel proud—even when they should

      Jessie Mahoney, MD | Physician
    • If I had to choose: Choosing the patient over the protocol

      Patrick Hudson, MD | Physician
    • How a TV drama exposed the hidden grief of doctors

      Lauren Weintraub, MD | Physician
    • Why adults need to rediscover the power of play

      Anthony Fleg, MD | Physician
    • How collaboration across medical disciplines and patient advocacy cured a rare disease [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why medical students are trading empathy for publications

      Vijay Rajput, MD | Education
    • Physician patriots: the forgotten founders who lit the torch of liberty

      Muhamad Aly Rifai, MD | Physician
    • The hidden cost of becoming a doctor: a South Asian perspective

      Momeina Aslam | Education
    • Why fixing health care’s data quality is crucial for AI success [PODCAST]

      Jay Anders, MD | Podcast
    • Closing the gap in respiratory care: How robotics can expand access in underserved communities

      Evgeny Ignatov, MD, RRT | Tech
    • Reclaiming trust in online health advice [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • How scales of justice saved a doctor-patient relationship

      Neil Baum, MD | Physician
    • A faster path to becoming a doctor is possible—here’s how

      Ankit Jain | Education
    • Make cognitive testing as routine as a blood pressure check

      Joshua Baker and James Jackson, PsyD | Conditions
    • How dismantling DEI endangers the future of medical care

      Shashank Madhu and Christian Tallo | Education
    • The broken health care system doesn’t have to break you

      Jessie Mahoney, MD | Physician
  • Recent Posts

    • Why fixing health care’s data quality is crucial for AI success [PODCAST]

      Jay Anders, MD | Podcast
    • Why so many physicians struggle to feel proud—even when they should

      Jessie Mahoney, MD | Physician
    • If I had to choose: Choosing the patient over the protocol

      Patrick Hudson, MD | Physician
    • How a TV drama exposed the hidden grief of doctors

      Lauren Weintraub, MD | Physician
    • Why adults need to rediscover the power of play

      Anthony Fleg, MD | Physician
    • How collaboration across medical disciplines and patient advocacy cured a rare disease [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...