"Sign right here and you're good to go": a content analysis of audiotaped emergency department discharge instructions

Ann Emerg Med. 2011 Apr;57(4):315-322.e1. doi: 10.1016/j.annemergmed.2010.08.024. Epub 2010 Oct 29.


Study objective: The goal of this study is to quantitatively and qualitatively assess the quality and content of verbal discharge instructions at 2 emergency departments (EDs).

Methods: This was a secondary data analysis of 844 ED audiotapes collected during a study of patient-emergency provider communication at 1 urban and 1 suburban ED. ED visits of nonemergency adult female patients were recorded with a digital audiotape. Of 844 recorded ED visits, 477 (57%) audiotapes captured audible discharge instructions suitable for analysis. Audiotapes were double coded for the following discharge content: (1) explanation of illness, (2) expected course, (3) self-care, (4) medication instructions, (5) symptoms prompting return to the ED, (6) time-specified for follow-up visit, (7) follow-up care instructions, (8) opportunities for questions, and (9) patient confirmation of understanding. Analysis included descriptive statistics, χ(2) tests, 2-sample t tests, and logistic regression models.

Results: Four hundred seventy-seven of 871 (55%) patient tapes contained audible discharge instructions. The majority of discharges were conducted by the primary provider (emergency physician or nurse practitioner). Ninety-one percent of discharges included some opportunity to ask questions, although most of these were minimal. Only 22% of providers confirmed patients' understanding of instructions.

Conclusion: Verbal ED discharge instructions are often incomplete, and most patients are given only minimal opportunities to ask questions or confirm understanding.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Communication
  • Comprehension
  • Emergency Service, Hospital* / standards
  • Female
  • Humans
  • Male
  • Patient Discharge* / standards
  • Patient Education as Topic / standards
  • Physician-Patient Relations
  • Retrospective Studies
  • Self Care
  • Tape Recording