135 Teach-back of discharge instructions in the ED CHAPTER 6 teach-back, 65 (97%) did not address negative feelings about repeating the discharge instructions. Teach-back was considered by many of them to be a logical element in the discharge process and was perceived as a useful educational tool to learn key information needed to continue care after discharge. For example, one patient expressed, “It [teach-back] is a very useful check to see if I understood it [discharge instructions] correctly.” According to participants, teach-back also helped them leave the ED more self-assured about performing self-care tasks. One patient illustrated this by saying, “This confirmation made me more confident to go home and take care of myself”. Discussion This study evaluated the effects of teach-back at ED discharge on ED revisits and on outcomes for older patients. Although no significant associations were found between the use of teach-back and a reduction in short-term ED revisits, the pre–post differences in ED revisits indicate that teach-back may be a useful strategy to reduce potentially unnecessary use of medical services. (30–32, 36, 37) The results of this pilot study also suggest that the use of teach-back has positive effects on older patient outcomes. We found associations between the use of teach-back and better short-term knowledge retention of discharge instructions by older patients, regardless of their clinical and cognitive condition. Improved knowledge retention was particularly found in the domains where recall deficits and incomprehension of instructions most frequently occur [6, 38, 39], namely, instructions related to prescribed medication and follow-up appointments. Better knowledge retention of instructions in these domains could reduce postdischarge noncompliance [12, 14] adverse drug events [40, 41], deterioration of health [10, 15, 16] and the use of health services [10, 15, 16]. The relatively large proportion of older patients with partial to no retention of instructions provided at the ED is in line with previous studies [6–10, 37, 38] and shows once again that further effort is needed to improve patient understanding and retention of instructions provided during an ED visit. We found no strong evidence for teach-back as a supportive method for improving the overall activation of self-management of health and healthcare postdischarge. A positive, although not very reliable, association was found between teach-back at ED discharge and a higher confidence among older patients to determine when to seek medical care (and when to handle a health problem themselves). With this improved level of activation, patients may be able to make better decisions affecting their health [42, 43] and are less likely to be in need of emergency care and hospitalisation [44, 45].
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