Dazed and Confused After E.R.
The vast majority of emergency room patients are discharged without understanding the treatment they received or how to care for themselves once they get home. A new study following patients from two Michigan hospitals shows that 78 percent of patients did not understand at least one of four elements of their hospital care. The four elements considered were: their diagnosis, their E.R. treatment, instructions for their at-home care and warning signs of when to return to the hospital.
This lack of understanding can lead to medication errors and serious complications that can send a patient right back to the hospital. The greatest confusion surrounded home care — instructions about things like medications, rest, wound care and when to have a follow-up visit with a doctor.
Dr. Paul M. Schyve, senior vice president of The Joint Commission, the national organization that accredits hospitals, said: “This study showed that this is much more common than you think. It’s not the rare patient.”
Similar results have been found for patients leaving hospitals, not just emergency rooms. This lack of understanding may explain why about 18 percent of Medicare patients discharged from a hospital are readmitted within 30 days.
Older patients are particularly vulnerable and the new study found that people were not aware of what they did not understand, thus simply asking a patient if he understands is not enough. The problem is particularly dangerous with respect to prescribed drugs. A patient-education program used in 130 health delivery systems across the country found that about 40 percent of patients 65 or older have a medication error after they leave the hospital. A 2006 report by the Institute of Medicine found that doctors and nurses were contributing to these errors by not providing information in an effective way.
Everything is exaggerated in the emergency department. Doctors are harried, they have little time to go over complicated information and they do not know the patients. Most patients are anxious, upset and not likely to be thinking clearly.
To provide further incentive to hospitals to address the communication problem, the Medicare Payment Advisory Commission, a government agency that advises Congress on Medicare issues, has recommended a policy change that would reduce payments to hospital with excessive readmission rates. It has also asked Medicare to allow hospitals to reward physicians who help lower readmission rates.