The Impact of Teach-Back Method on Retention of Key Domains of Emergency Department Discharge Instructions

J Emerg Med. 2017 Nov;53(5):e59-e65. doi: 10.1016/j.jemermed.2017.06.032. Epub 2017 Sep 20.


Background: Studies have shown that patient understanding and recall of their emergency department (ED) discharge instructions is limited. The teach-back method involves patients repeating back what they understand, in their own words, so that discharge providers can confirm comprehension and correct misunderstandings.

Objective: The objective of this study was to determine if the teach-back method would increase retention of post ED discharge instructions.

Methods: A before-and-after study design (pre and post teach-back method) was used at an academic Midwestern institution. After discharge, patients were asked a set of standardized questions regarding their discharge instructions via telephone interview. Answers were compared with the participant's discharge instructions in the electronic medical record. A composite score measuring mean percent recall correct was calculated in four categories: diagnosis, medication reconciliation, follow-up instructions, and return precautions. Data were collected for 1 week prior to and 1 week post intervention. One additional week between the pre- and postintervention phases included training and practice behavior adoption. The primary outcome was mean percent recall correct between the two groups assessed by a Mann-Whitney U test, and adjusted for confounders with an analysis of covariance model.

Results: The mean percent recall correct in the teach-back phase was 79.4%, or 15 percentage points higher than the preintervention group. After adjusting for age and education, the adjusted model showed a recall rate of 70.0% pre vs. 82.1% (p < 0.005) post intervention.

Conclusions: The teach-back method had a positive association on retention of discharge instructions in the ED regardless of age and education.

Keywords: discharge instructions; emergency department; teach-back method.

MeSH terms

  • Adult
  • Comprehension
  • Electronic Health Records / statistics & numerical data
  • Emergency Service, Hospital / organization & administration
  • Emergency Service, Hospital / statistics & numerical data
  • Female
  • Humans
  • Male
  • Medication Adherence / psychology
  • Middle Aged
  • Patient Discharge / standards
  • Patient Discharge Summaries / standards*
  • Retention, Psychology*
  • Statistics, Nonparametric
  • Surveys and Questionnaires
  • Teaching / psychology
  • Teaching / standards