The emergency department discharge is the most critical aspect of the patient flow process, but often, it’s the most challenging. As this article in the Annals of Emergency Medicine points out, three important tasks have to be properly executed for a successful discharge:
“At patient discharge, the emergency provider must effectively complete 3 tasks: communicate the crucial information, verify comprehension, and tailor teaching to areas of confusion or misunderstanding to ensure patient safety in the home environment.”
The complexity of the discharge process lies in the fact that it has to be standardized for efficiency, but also flexible to address varied health literacy levels and cultural backgrounds.
“Too often, however, discharge communication becomes an afterthought, limited only to a brief exchange of forms and prescriptions, leaving patients with uncertainty about the care plan and at risk of errors in medication use,” the authors state. “Patients and families with limited health literacy or language fluency are likely to be at particular risk of departing from the ED with insufficient comprehension.”
So, what do proper discharge practices mean for patient safety and quality of care in the ED?
First, an effective discharge process is key to significantly reducing emergency department readmissions. Often, patients have a difficult time understanding instructions related to medication and dosage, proper home care, and what the follow-up process entails. All of these areas represent potential “knowledge gaps” for patients and could result in a return visit to the ED if discharge instructions aren’t effectively communicated. And I can’t stress enough the importance of relaying proper instructions regarding medications. Recent reports suggest nearly 35 percent of ED visits among people 65 and older were due to adverse drug events.
Focusing on the discharge process is also a relatively simple and low-cost strategy to improve quality of care, patient safety, and reduce crowding — your biggest investment will be time. If you don’t have a strong discharge checklist in place, I recommend starting there. Next, evaluate the communication strategies and language utilized by staff. Do they offer enough flexibility to efficiently communicate key instructions about care and follow-up to patients from diverse backgrounds? If not, determine which patient groups are most at-risk for readmission, such as the elderly or homeless. Consider tailoring checklists for each group if possible, and communicate with staff the importance of taking the time to ensure comprehension of discharge instructions.
It’s also crucial to remember that family members and caregivers play a tremendous role in the well-being of patients upon discharge. Empower these individuals with the knowledge necessary for their loved one’s improved health, ensuring they understand all discharge instructions and are comfortable with any duties they may have to perform at home.
The discharge process is a prime opportunity to improve the health literacy of patients as well as outcomes, safety, and quality. It’s important to routinely evaluate communication strategies used during the discharge process and any interaction between patient/caregiver and staff. If you’re a hospital or ED leader looking to retool your discharge procedures, feel free to drop me a line to schedule a complimentary phone consultation to discuss what steps you can take to improve this important component of the patient flow process.
Annals of Emergency Medicine: “Effective Discharge Communication in the Emergency Department”
Academic Emergency Medicine: “Patient understanding of emergency department discharge instructions: where are knowledge deficits greatest?”
The Agency for Healthcare Quality and Research: Preventing Avoidable Readmissions