Department of Emergency Medicine , Northwestern University, Chicago, IL, USA.
Acad Emerg Med. 2012 Sep;19(9):E1035-44. doi: 10.1111/j.1553-2712.2012.01425.x.
Many patients are discharged from the emergency department (ED) with an incomplete understanding of the information needed to safely care for themselves at home. Patients have demonstrated particular difficulty in understanding post-ED care instructions (including medications, home care, and follow-up). The objective of this study was to further characterize these deficits and identify gaps in knowledge that may place the patient at risk for complications or poor outcomes.
This was a prospective cohort, phone interview-based study of 159 adult English-speaking patients within 24 to 36 hours of ED discharge. Patient knowledge was assessed for five diagnoses (ankle sprain, back pain, head injury, kidney stone, and laceration) across the following five domains: diagnosis, medications, home care, follow-up, and return instructions. Knowledge was determined based on the concordance between direct patient recall and diagnosis-specific discharge instructions combined with chart review. Two authors scored each case independently and discussed discrepancies before providing a final score for each domain (no, minimal, partial, or complete comprehension). Descriptive statistics were used for the analyses.
The study population was 50% female with a median age of 41 years (interquartile range [IQR] = 29 to 53 years). Knowledge deficits were demonstrated by the majority of patients in the domain of home care instructions (80%) and return instructions (79%). Less frequent deficits were found for the domains of follow-up (39%), medications (22%), and diagnosis (14%). Minimal or no understanding in at least one domain was demonstrated by greater than two-thirds of patients and was found in 40% of cases for home care and 51% for return instructions. These deficits occurred less frequently for domains of follow-up (18%), diagnosis (3%), and medications (3%).
Patients demonstrate the most frequent knowledge deficits for home care and return instructions, raising significant concerns for adherence and outcomes.
许多患者从急诊科（ED）出院时，对在家安全护理所需的信息理解不完整。患者在理解 ED 后护理说明（包括药物、家庭护理和随访）方面尤其困难。本研究的目的是进一步描述这些缺陷，并确定可能使患者面临并发症或不良结局风险的知识差距。
这是一项前瞻性队列、基于电话访谈的研究，在 ED 出院后 24 至 36 小时内纳入了 159 名成年英语患者。通过以下五个领域评估患者对五种诊断（踝关节扭伤、背痛、头部损伤、肾结石和裂伤）的知识：诊断、药物、家庭护理、随访和返回说明。知识是根据直接患者回忆与特定诊断的出院说明的一致性以及图表审查确定的。两位作者独立对每个病例进行评分，并在提供每个领域的最终评分之前讨论差异（无、最小、部分或完全理解）。分析采用描述性统计。
研究人群中 50%为女性，中位数年龄为 41 岁（四分位距 [IQR] = 29 至 53 岁）。大多数患者在家庭护理说明（80%）和返回说明（79%）领域存在知识缺陷。随访（39%）、药物（22%）和诊断（14%）领域发现的缺陷较少。超过三分之二的患者在至少一个领域表现出轻微或完全不理解，其中 40%的家庭护理和 51%的返回说明存在这种情况。在随访（18%）、诊断（3%）和药物（3%）领域，这些缺陷发生的频率较低。
患者在家庭护理和返回说明方面表现出最频繁的知识缺陷，这对治疗依从性和结局提出了重大担忧。
