February 13, 2018 | Susan Pasley, MS, BSN, RN
Discharge: Education (Part 2 of 5)
Emergency departments (EDs) must incorporate a variety of educational methods to combat the myriad factors that contribute to poor comprehension. According to the US Department of Education and the National Institute of Literacy, 32 million American adults can’t read above a fifth-grade level, and 19 percent of high school graduates can’t read at all. According to the Office of Disease Prevention and Health Promotion, only 12 percent of American adults have proficient health literacy. Innovative approaches to education delivery modalities and assessment techniques can both help identify and bridge this gap in the ED.
Basic patient education is a standard process of every ED discharge. This teaching process is often associated with the formal act of providing the patient with the discharge packet that includes written instructions about their diagnosis, medications and follow-up. However, given the breadth of topics that must be covered to deliver a high-quality discharge, the education process must start at the beginning of the visit as you teach your patients about the care they are receiving.
When designing a discharge education program, there are three important areas that must be addressed. The content of the materials provided and the areas covered must be comprehensive while simultaneously avoiding inundation of the patient with unnecessary information. The content cannot be left to stand alone as the sole delivery method of key concepts. Quality verbal reinforcement is essential to patients’ comprehension. Lastly, you must assess understanding and reeducate accordingly prior to releasing a patient from your care.
Written discharge instructions are a standard of care observed in every ED. With the proliferation of electronic health records and best of breed software solutions, the ability to generate diagnosis and medication specific information is simple. However, the ease with which this information is available does not alone guarantee its efficacy. Studies demonstrate that printed discharge instructions increase understanding, and increase follow-up compliance in both pediatric and adult patient populations, but it is less effective in decreasing 72-hour returns. Information, whether written or verbal, must be provided clearly and concisely, devoid of medical jargon, at an appropriate educational level, and in the patient’s native language.
Just like you, patients have a preferred learning style. They may lean towards visual, verbal, aural, or tactile content to fully comprehend complex concepts. Organizations that can provide content in multiple modalities will benefit from increased patient comprehension. With the proliferation of video and access to easy distribution through channels like YouTube and Vimeo, the ability to provide patients with visual and auditory education has improved. Early research in this area shows great promise. In a study of 133 ED patients, those who viewed a diagnosis-specific discharge instruction after leaving scored 19 percent higher on comprehension than those who were discharged with standard written instructions alone.
Assessing your patient’s level of comprehension is an essential step of any high-quality discharge and should include evaluation of key aspects of the diagnosis, self-care, return criteria, medications and follow-up instructions. Although you may feel that you have accurately communicated all necessary information, we know from research that patients often misunderstand, misinterpret or forget. Kessels (2003) found that patients immediately forget 40-80 percent of the medical information they receive. This is especially true in the high anxiety, stressful environment of the ED.
Teach back is a method to confirm that the patient understood what you communicated by demonstrating or teaching back the information. Teach back has been shown to be an effective tool for healthcare providers, and many organizations consider it an “always event,” or something that must happen with every patient discharge. Implementation of teach back in the ED not only allows you to assess patients’ understanding, but it also streamlines your ability to efficiently tailor your teaching to topics your patient misunderstood. This can significantly reduce the time it takes to review every aspect of discharge.
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