NCPA - National Center for Policy Analysis


September 17, 2008

A vast majority of emergency room patients are discharged without understanding the treatment they received or how to care for themselves once they get home, researchers say.  And that can lead to medication errors and serious complications that can send them right back to the hospital.

In a new study, researchers followed 140 English-speaking patients discharged from emergency departments in two Michigan hospitals and measured their understanding in four areas -- their diagnosis, their E.R. treatment, instructions for their at-home care and warning signs of when to return to the hospital.

They found that:

  • About 78 percent of patients did not understand at least one area and about half did not understand two or more areas.
  • 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.
  • About 18 percent of Medicare patients discharged from a hospital are readmitted within 30 days.
  • Doctors and patients say that with hospitals pressed to see more patients faster, patients get less attention.

The problem is particularly acute when it comes to drugs.  About 40 percent of patients 65 or older have a medication error after they leave the hospital.  Doctors and nurses are contributing to these errors by not providing information in an effective way.

And until recently, poor communication was largely ignored by hospitals, but now they are being forced to face their communication inadequacies.  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.

Source: Laurie Tarken, "E.R. Patients Often Left Confused After Visits," New York Times, September 16, 2008; based upon: Kirsten G. Engel, et al., "Patient Comprehension of Emergency Department Care and Instruction: Are Patients Aware of When They Do Not Understand?" Annals of Emergency Medicine, July 11, 2008.

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