123 Teach-back of discharge instructions in the ED CHAPTER 6 Introduction Providing patients and proxies adequate discharge instructions is an important task of healthcare professionals to ensure a safe discharge from hospital to home.[1] Educating patients and proxies at discharge can however be challenging for professionals working in the ED due to various reasons. First, an ED visit is usually an unexpected and stressful event for patients. They often experience on-going acute pain and fatigue, and are worried about their health situation,[2,3] which makes it difficult to concentrate on the provided information. Second, the ED can be a crowded and hectic working environment where discharge instructions are provided quickly and piecemeal in-between other care activities, thereby making it difficult for patients and proxies to remember or reproduce them.[4,5] Many studies have demonstrated that patients often leave the ED unprepared because of comprehension deficits in key information domains such as the diagnosis and cause, ED treatment, post-ED care and return precautions.[6-10] The results from a cross-sectional analysis demonstrated for example, that three out of four patients were unable to recall important information for at least one of these domains.[6] Furthermore, patients may not recognize when they have limited understanding,[6,11] suggesting an inability to seek help when needed. Incomprehension of discharge instructions has been associated with negative outcomes such as unmet needs,[12] poor compliance,[12-14] deterioration of health,[10,15,16] and increased use of health services post-discharge.[10,15,16] A variety of strategies have been developed and tested to improve comprehension and recall of discharge instructions, primarily focusing on the content of the instructions and the method of delivery (e.g., verbal, written, pictorial, video, telephone).[1,8] Another improvement strategy is the ‘teach-back’ method whereby patients or proxies are asked to repeat back, in their own words or in demonstrations, the instructions that healthcare professionals provided them, so that full comprehension of the instructions can be confirmed, misunderstandings can be corrected and additional information can be provided if needed.[17,18] As mentioned previously by Griffey and colleagues,[11] the teach-back approach has a basis in cognitive psychology experiments showing that repeating short sequences of information helps to improve the recall of information.[19-21] The use of the teach-back method showed positive effects on a variety of outcomes for different patient populations across inpatient and outpatient healthcare settings.[18,22,23] However, this communication method has been largely underexamined for patients, particularly older adults, discharged from the ED. This is remarkable considering that older adults are extra vulnerable for not comprehending and retaining important discharge
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