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Emergency department discharge instructions comprehension and compliance study

Published online by Cambridge University Press:  21 May 2015

Collin Clarke ,
Steven Marc Friedman ,
Kevin Shi ,
Tamara Arenovich ,
Jose Monzon  and
Christopher Culligan
Collin Clarke
Affiliation:
University of Toronto, Toronto, Ont.
Steven Marc Friedman*
Affiliation:
Emergency Medicine, University Health Network, Toronto, Ont.; Assistant Professor, Faculty of Medicine, University of Toronto, Toronto, Ont.
Kevin Shi
Affiliation:
University of Toronto Medical School, Toronto, Ont.
Tamara Arenovich
Affiliation:
Clinical Studies Resource Centre, University Health Network, Toronto, Ont.
Jose Monzon
Affiliation:
University of Toronto, Toronto, Ont.
Christopher Culligan
Affiliation:
Emergency Medicine, University Health Network, Toronto, Ont.
*
1F 502, Toronto Western Hospital, 399 Bathurst St., Toronto ON M5T 2S8; 416 603-5405, fax 416 603-5324, steven.friedman@uhn.on.ca

Abstract

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Objectives:

To assess patient comprehension of emergency department discharge instructions and to describe other predictors of patient compliance with discharge instructions.

Methods:

Patients departing from the emergency department of an inner-city teaching hospital were invited to undergo a structured interview and reading test, and to participate in a follow-up telephone interview 2 weeks later. Two physicians, blinded to the other's data, scored patient comprehension of discharge information and compliance with discharge instructions. Inter-rater reliability was assessed using a kappa-weighted statistic, and correlations were assessed using Spearman's rank correlation coefficient and Fisher's exact test.

Results:

Of 106 patients approached, 88 (83%) were enrolled. The inter-rater reliability of physician rating scores was high (kappa = 0.66). Approximately 60% of subjects demonstrated reading ability at or below a Grade 7 level. Comprehension was positively associated with reading ability (r = 0.29, p = 0.01) and English as first language (r = 0.27, p = 0.01). Reading ability was positively associated with years of education (r = 0.43, p < 0.0001) and first language (r = 0.24, p = 0.03), and inversely associated with age (r = -0.21, p = 0.05). Non-English first language and need for translaor were associated with poorer comprehension of discharge instructions but not related to compliance. Compliance with discharge instructions was correlated with comprehension (r = 0.31, p = 0.01) but not associated with age, language, education, years in anglophone country, reading ability, format of discharge instructions, follow-up modality or association with a family physician.

Conclusions:

Emergency department patients demonstrated poor reading skills. Comprehension was the only factor significantly related to compliance; therefore, future interventions to improve compliance with emergency department instructions will be most effective if they focus on improving comprehension.

Keywords

comprehensioncompliancedischargereading
Type
ED Administration • L’administration de la MU
Information
Canadian Journal of Emergency Medicine , Volume 7 , Issue 1 , January 2005 , pp. 5 - 11
Copyright
Copyright © Canadian Association of Emergency Physicians 2005

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