Emergency department discharge instructions comprehension and compliance study

ABSTRACTObjectives:To assess patient comprehension of emergency department discharge instructions and to describe other predictors of patient compliance with discharge instructions.Methods:Patients departing from the emergency department of an inner-city teaching hospital were invited to undergo a structured interview and reading test, and to participate in a follow-up telephone interview 2 weeks later. Two physicians, blinded to the other's data, scored patient comprehension of discharge information and compliance with discharge instructions. Inter-rater reliability was assessed using a kappa-weighted statistic, and correlations were assessed using Spearman's rank correlation coefficient and Fisher's exact test.Results:Of 106 patients approached, 88 (83%) were enrolled. The inter-rater reliability of physician rating scores was high (kappa = 0.66). Approximately 60% of subjects demonstrated reading ability at or below a Grade 7 level. Comprehension was positively associated with reading ability (r= 0.29, p= 0.01) and English as first language (r= 0.27, p= 0.01). Reading ability was positively associated with years of education (r= 0.43, p< 0.0001) and first language (r= 0.24, p= 0.03), and inversely associated with age (r= -0.21, p= 0.05). Non-English first language and need for translaor were associated with poorer comprehension of discharge instructions but not related to compliance. Compliance with discharge instructions was correlated with comprehension (r= 0.31, p= 0.01) but not associated with age, language, education, years in anglophone country, reading ability, format of discharge instructions, follow-up modality or association with a family physician.Conclusions:Emergency department patients demonstrated poor reading skills. Comprehension was the only factor significantly related to compliance; therefore, future interventions to improve compliance with emergency department instructions will be most effective if they focus on improving comprehension.