BWH/MGH Harvard Affiliated Emergency Medicine Residency, Boston, MA, USA.
Ann Emerg Med. 2012 Aug;60(2):152-9. doi: 10.1016/j.annemergmed.2011.10.023. Epub 2012 Jan 4.
Communication at discharge is an important part of high-quality emergency department (ED) care. This review describes the existing literature on patient understanding and implementation of discharge instructions, discusses previous interventions aimed at improving the discharge process, and recommends best practices and future research. MEDLINE and Cochrane databases were searched, using combinations of key terms. Literature from both the adult and pediatric ED populations was reviewed. Multiple reports have shown deficient comprehension at discharge, with patients or parents frequently unable to report their diagnosis, management plan, or reasons to return. Interventions to improve discharge communication have been, at best, moderately successful. Patients need structured content, presented verbally, with written and visual cues to enhance recall. Written instructions need to be provided in the patient's language and at an appropriate reading level. Understanding should be confirmed before the patient leaves the ED. Further research is needed to describe the optimal content, channel, and timing for the ED discharge process and the relationship between discharge process and outcomes.
出院沟通是高质量急诊科（ED）护理的重要组成部分。本综述描述了现有的关于患者对出院医嘱的理解和执行的文献，讨论了旨在改善出院流程的先前干预措施，并提出了最佳实践和未来研究建议。检索了 MEDLINE 和 Cochrane 数据库，使用了关键词组合。综述了来自成人和儿科 ED 人群的文献。多项报告显示出院时理解能力不足，患者或家长经常无法报告其诊断、管理计划或复诊原因。改善出院沟通的干预措施充其量只是取得了一定程度的成功。患者需要有结构化的内容，以口头形式呈现，并辅以书面和视觉提示以增强记忆。书面说明需要用患者的语言提供，并具有适当的阅读水平。在患者离开 ED 之前，应确认其是否理解。需要进一步研究来描述 ED 出院流程的最佳内容、渠道和时间，以及出院流程与结果之间的关系。
