RESUMEN
STUDY OBJECTIVE: Patients discharged from the emergency department (ED) should be informed comprehensively and accurately about the diagnosis, future examinations and follow-up care. This study investigates: (1) how comprehensively patients are informed by physicians on discharge; (2) how accurately patients remember this information after discharge; (3) how well informed overall patients leave the ED; and (4) whether informedness relates to patient satisfaction. METHODS: This study compares: (1) information given during discharge conversations, based on audio recordings of the conversations, with (2) accuracy of patient recall of this information, based on postdischarge interviews. During these interviews, the authors also assessed (3) amount and accuracy of information provided during treatment. Furthermore, the authors obtained (4) satisfaction ratings by physicians and patients. Data were collected for 96 patients during 20 shifts. RESULTS: Sufficient information was provided in 83% of discharge conversations. Patients correctly recalled 82% of information received about diagnosis, 56% about examinations planned and 72% about follow-up treatments. Information related to medication was most prone to forgetting or distortion. Altogether, 43% of the patients left the ED correctly informed about diagnosis, planned examinations and follow-up. Patient satisfaction ratings were high (mean 4.7 on a 5-point Likert Scale) and not related to informedness of the patient. CONCLUSIONS: Patients had important information deficits when leaving the ED, and information transmission needs to be improved. The physician-patient discharge conversation seems an ideal opportunity for enhancing patient informedness. Standardisation of discharge procedures and training physicians in how to ensure that patients actually understand the information provided are needed.
Asunto(s)
Servicio de Urgencia en Hospital , Alta del Paciente/normas , Educación del Paciente como Asunto/normas , Adulto , Actitud del Personal de Salud , Comunicación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Satisfacción del Paciente , Relaciones Médico-PacienteRESUMEN
OBJECTIVE: This study used a high-fidelity simulation to examine factors influencing the accuracy of 201 pieces of information transmitted to nurses and physicians joining a medical emergency situation. BACKGROUND: Inaccurate or incomplete information transmission has been identified as a major problem in medicine. However, only a few studies have assessed possible causes of transmission errors. METHOD: Each of 20 groups was composed of two or three nurses (first responders), one resident joining the group later, and one senior doctor joining last. Groups treated a patient suffering a cardiac arrest. RESULTS: Multilevel binomial analyses showed that 18% of the information given to newcomers was inaccurate. Quantitative information requiring repeated updating was particularly error prone. Information generated earlier (i.e., older information) was more likely to be transmitted inaccurately. Explicitly encoding information to be transmitted after the physicians arrived at the scene enhanced accuracy, supporting transfer-appropriate processing theory. CONCLUSION: Information transmitted to nurses and physicians who join an ongoing emergency is only partly reliable. Therefore, medical professionals should not take accuracy for granted and should be aware of the nature of transmission errors. APPLICATION: Medical professionals should be trained in adequate encoding of information and in standardized communication procedures with regard to error-prone information. In addition, technical devices should be implemented that reduce reliance on memory regarding information with error-prone characteristics.