Adding video or written materials to standard verbal education upon release from the emergency department (ED) may enhance patient recall of discharge instructions, according to study results published in Annals of Emergency Medicine.
Researchers performed a systematic review of PubMed, Excerpta Medica dataBASE, Web of Science, Google Scholar, and Cochrane databases to identify articles focused on discharge instructions in the ED. They used this information to assess differences in comprehension or recall of verbal, verbal plus written, and verbal plus video discharge instructions. The researchers examined all relevant studies published before March 15, 2018, excluding articles not written in English.
Of all the articles screened (N=1842), only 51 met the inclusion and exclusion criteria. Of these, 12 used verbal discharge instructions only, 30 used written instructions, 7 used video instructions, and 2 used telephone instructions. Of the studies that assessed recall of verbal discharge instructions and recall of written instructions, correct recall ranged from 8% to 94% for patients receiving verbal instructions and 7% to 31% for those receiving written instructions. Correct recall ranged from 54% to 89% for patients receiving video discharge instructions. The study designs included observational cross-sectional studies and randomized controlled trials.
For each study, patient data were extracted for age, gender, education level, and language barrier, as well as type of discharge instructions given (verbal, written, video, telephone, or all 4), the method used to measure correct recall, percentage of correct recall, and domain of patient education in which recall was measured. The outcome measure was comprehension and recall of discharge instructions [WU1] [KT2] following the ED visit.
A meta-analysis using a random-effects model was conducted on data gathered from 1460 patients who received verbal discharge instructions only, 3395 patients who received written instructions, and 459 patients who received video instructions to determine overall pooled correct recall of verbal, written, and video discharge instructions. The pooled data revealed differences in correct recall across the types of discharge instructions. Patients who received video instructions had 66.8% correct recall (95% CI, 57.9-75.7), followed by 57.8% correct recall for patients who received written instructions (95% CI, 44.2-71.2) and 47% for patients who received verbal instructions (95% CI, 32.2-61.7).
Study limitations included the difficulty in directly comparing methods of discharge instructions due to variance in each method, different definitions of recall, different ways of measuring recall, and heterogeneity in patient populations. Additionally, the use of verbal instructions in concert with other methods may have influenced recall of written or video instructions as these methods are rarely used in isolation. Finally, since the study focused on correct recall of diagnosis, treatment, follow-up, and return instructions, effect of recall on symptoms or recovery of ED patients was not assessed.
The researchers concluded that verbal-only ED discharge instructions may be insufficient to ensure appropriate patient education. Providing additional video or written instructions to patients at discharge from the ED has the potential to enhance their comprehension and recall of important discharge information.
Hoek AE, Anker SCP, van Beeck EF, Burdorf A, Rood PPM, Haagsma JA. Patient discharge instructions in the emergency department and their effects on comprehension and recall of discharge instructions: a systematic review and meta-analysis [published online August 19, 2019]. Ann Emerg Med. doi: 10.1016/j.annemergmed.2019.06.008