Washington, DC- More than three-quarters of patients (78 percent) do not fully understand the care and discharge instructions they receive in the emergency department, and the vast majority of them are unaware that they do not understand what doctors have told them, according to a study published today online in the Annals of Emergency Medicine ("Patient Comprehension of Emergency Department Care and Instructions: Are Patients Aware of When They Don't Understand?").

"It is critical that emergency patients understand their diagnosis, their care, and perhaps most important, their discharge instructions," said study author Dr. Kirsten Engel of Northwestern University in Chicago, Il.  "It is disturbing that so many patients do not understand their post-emergency department care, and that they do not even recognize where the gaps in understanding are.  Patients who fail to follow discharge instructions may have a greater likelihood of complications after leaving the emergency department."

Study authors assessed 138 patients and 2 caretakers in four categories of comprehension: Diagnosis and cause, emergency department care, post-emergency department care and return instructions.  More than half (51 percent) did not understand fully what they were told in two or more categories.  More than one-third (34 percent) of the comprehension deficiencies involved patients' understanding of post-emergency department care, while 15 percent involved diagnosis and cause.  Of those patients with comprehension difficulties, only 20 percent realized that their understanding was incomplete or inaccurate.

"The bottom line is that we need better strategies for identifying patients who are having difficulty understanding their care and instructions in the emergency department," said Dr. Engel.  "The chaotic nature of the emergency department environment poses significant challenges to communication.  We can, however, strive to minimize communication failures by determining why they occur and how we may intervene to reduce or prevent them.  This will be critical to improving  patient care in the emergency department."

Patients can help themselves by asking emergency department staff to repeat themselves or clarify points that remain unclear.  When possible, patients may benefit by bringing a family member or friend with them to the emergency department who can ask questions and help remember the patient's post emergency department care instructions.

"When you are in the emergency department, be honest and don't be afraid to ask questions," said Dr. Engel.  "I care about all of my patients, but nobody cares about your health as much as you do.  If you don't understand what the doctor has told you, keep asking questions until you do.  That's what we're there for."

Annals of Emergency Medicine is the peer-reviewed scientific journal for the American College of Emergency Physicians, a national medical society with more than 26,000 members. ACEP is committed to advancing emergency care through continuing education, research, and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies. For more information visit www.acep.org.

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