Simplification of Emergency Department Discharge Instructions Improves Patient Comprehension☆,☆☆,★
Section snippets
INTRODUCTION
Approximately 13% of the adult population in the United States is functionally illiterate.1 In general, functional illiteracy corresponds to an inability to read at the fourth-grade level.2 Our previous research efforts have shown that a large proportion of our patients have difficulty understanding standard written instructions.3 Simplification of those instructions could benefit patients by making important information easier to understand.
This study was undertaken to discern the ability of
MATERIALS AND METHODS
In our previous study, two sets of standard written discharge instructions—"Wound Instructions" and "Sprains and Bruises"— were chosen from the standardized discharge instructions available in our ED (Figure 1). Patients' abilities to answer five written questions based on the information contained in these instructions were previously reported3 and served as historical controls in the current study. For this study, the previously tested instruction sheets were simplified (Figure 2), and new
RESULTS
Of 895 patients considered, 440 (47.3%) were entered into the study. The sample population (n=440) was well matched to the population in the original study (n=400) for sex, age, and education. Differences in scores for men and women were not significantly different. There was no significant statistical difference in scores between the two improved (simplified) instruction sets. The mean score obtained in the current study (simplified instructions), 4.36±1.13, was significantly different from
DISCUSSION
A large subset of patients cannot read well enough to understand basic written materials. The scope of the illiteracy problem in the United States continues to be well documented. Davis et al4 examined reading ability in patients in substance misuse treatment centers, a population frequently seen in EDs. The authors examined patients in both private and public treatment settings using the PIAT-R test of reading ability. Although the patients in private settings performed, on average, at a
CONCLUSION
We have shown that patients' understanding of written discharge instructions improves with simplification of the language in the instructions. Simplified discharge instructions may help a group of patients who do not understand current standard materials. All EDs and health care facilities should strive to improve the written materials provided for patients. Future areas for improvement and investigation include the use of pictures, videotapes, and computer-based learning to facilitate patient
Acknowledgements
The authors thank Maria Brenneman, RN, for her assistance in developing improved discharge instructions.
References (5)
- et al.
Functional illiteracy among emergency department patients: A preliminary study
Ann Emerg Med
(1993) Adult Illiteracy Estimates for States
(1986)
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2020, Annals of Emergency MedicineCitation Excerpt :We assessed articles according to their way of generating comparable groups and found several randomized controlled trials24,47,54,56,57 and 6 2-phase cohort trials3,22,35,48,51,58 to have a high risk of bias. Because of a significant percentage of patients lost to follow-up, we judged 14 articles3,15,21,25,30,34,37,44-46,52,54,58,59 to have a high risk of incomplete data. Twenty articles did not describe the level of education6,15,17,20-22,24,27,29,35,39,44,46,48,52,53,55,58-60 and 9 articles did not mention whether there was a language barrier12,15,23,25,35,43,44,51,60 and therefore probably had selection bias.
The influence of information structuring and health literacy on recall and satisfaction in a simulated discharge communication
2018, Patient Education and Counseling
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From the Department of Emergency Medicine, The George Washington University Medical Center, Washington DC.
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Address for reprints: B Tilman Jolly, MD, Department of Emergency Medicine, The George Washington University Medical Center, 2140 Pennsylvania Avenue Northwest, Washington DC 20037, 202-994-3921, Fax 202-994-3924
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Reprint no. 47/1/66977