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Study shows "vast majority" of ER patients leave hospital with health-threatening confusion

The Annals of Emergency Medicine  published a study this week documenting that the "vast majority" of patients leaving two  Emergency Rooms in the State of Michigan lacked a fundamental understanding of the treatment they had received or how to care for their condition.  The researchers followed 140 English-speaking patients through discharge and found that 78 percent did not understand at least one of four areas of instruction, and about half did did not understand two or more.  The researchers had divided the discharge instructions into these categories:  1. diagnosis; 2. ER treatment; 3. instructions for at-home care; and 4. warning signs indicating a need to return to the hospital. 

The researchers stressed that elderly patients were particularly prone to misunderstanding or "non-compliance".  They attributed this outcome to impaired cognitive function (in about one-third of patients over 55), patient illness and anxiety, and the hurried and stressful ER environment.  Other studies have shown that about forty percent of patients over age 65 incur a medication error after discharge, and that inadequate instructions contributed to this outcome.  Responding to the findings in therse various studies, investigators are re-defining patient "non-compliance" to call it "health illiteracy", taking into account the problems of comprehension associated with a sick, anxious, and medically illiterate population, and time pressures and language issues involving care providers.

The reserarchers in the current study cited one example of a woman in her 20s who left the ER with antibiotics for a sexually-transmitted pelvic inflammatory disease, but took only her pain medication and did not avoid sexual activity:  she had not understood the root cause of the treatment provided and as a result her health and fertility, and the health of her spouse or functional equivalent was threatened.

Dr. Eric Coleman of the Care Transitions Program at the University of Colorado, and a spokesperson for the Joint Commission on Accreditation of Hospitals agreed that the problem of educating patients is widespread and needs to be addressed.  They and Dr. Michalel Radeos, research director of emergency medicine at New York Hospital Medical Center confirmed that the problem is one involving medical providers as well as patients.  "It is not the rare patient."  Communication problems leading to inadequate follow-up care contribute to the fact that 18 percent of Medicare patients are re-admitted to ERs within 30 days of discharge.  The Federal government is looking at proposals to reduce Medicare and Medicaid funding to hospitals that continue to experience unduly high re-admission rates:  rather than being a source of revenue for the institution involved, these  rapidly-retuning patients could actually cost them money (and justify more thorough concentration on discharge and follow-up instructions).

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