Navigating the Emergency Department Visit – Resources for Patients

Flickr: Photo by Ilmicrofono Oggiono

Author: Katrina A Gipson, MD MPH
Emergency Medicine Resident
University Hospitals Case Medical Center, Cleveland, OH
AAEM/RSA Advocacy Committee Member


Originally Published: in Modern Resident June/July 2014

This post was peer reviewed.
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The practice of medicine involves many players and involves a complex set of rules and bureaucracy. Navigating this bureaucracy is often difficult, and patients require a voice. The American Academy of Emergency Medicine’s Resident and Student Association (AAEM/RSA) seeks to advocate on behalf of both the professionals who practice emergency medicine and those who receive our services. In many ways, health care is a service like many others, with providers and consumers. A well-educated consumer is best able to take advantage of the services being provided. With this in mind, the Patient Advocacy Subcommittee of AAEM/RSA sought to create a set of brochures to act as a roadmap and inform the public of how best to navigate an emergency department visit and the treatments and information provided during a visit.

“Why didn’t I receive a clear diagnosis?” “Should I continue to take my antibiotics even though my symptoms have resolved?” “What resources are available for those with mental health disease after leaving the emergency department?” These are all questions commonly asked by our patients. The Patient Advocacy Subcommittee has compiled many resources which address these questions into one accessible location on the AAEM/RSA website: http:www.aaemrsa.org/resources/patient-and-discharge-resources. Here, readers will find printable brochures, in both color and black-and-white versions, to supplement patient education upon discharge from the emergency department.

While there is a plethora of websites offering patients medical advice, patients generally prefer printed material. Farnsworth sought to explore if the modality of patient education materials, online vs. print, affected their perceived accessibility for readers using a convenience sampling of first-year college students. This work suggested that some first-year college students, whose digital literacy on average exceeded that of the general public’s, perceived online patient education materials to be more complex than similar material presented in print-based form.[1] It also showed that the patients’ perceptions of the difficulty of the education material directly affected their ability to learn from the materials1. Thus, our brochures offer an alternative to online materials, which may intimidate some readers. The subcommittee is continually expanding its list of resources, with the hope that this growing list will act as an adjunct to hospitals’ preexisting electronic health record (EHR) and discharge instruction materials.

The implications of having these resources available are widespread. For instance, patients who are better informed on how to take their medication may be less prone to unnecessary return emergency department visits and hospital admissions.[2] Furthermore, patients who have realistic expectations of their emergency department visits may be more satisfied with their eventual outcome. Also, as busy emergency physicians, time constraints may make it difficult to clearly convey all of the necessary information with each patient encounter.[3] Though return visits and patient satisfaction are important matters, the true goal of our brochures is to improve actual health outcomes. Through a MEDLINE database search, Stewart was able to show a correlation between effective physician-patient communication and improved health outcomes such as emotional health, symptom resolution, physical function, physiologic measures (i.e., blood pressure and blood sugar level), and pain control.[4] Of the 21 randomized controlled trials and analytic studies meeting final criteria for review, 16 reported positive results emphasizing that the quality of communication during history taking and discussion of the management plan influence patient health outcomes.4 The Patient Advocacy Subcommittee’s brochures may serve as additional reinforcements of the treatment plans, thereby increasing the treatments’ efficacy.

Health care encounters are becoming increasingly difficult for patients to navigate as diagnoses become more obscure and treatments more complex. It is up to the emergency physician to provide not only optimal care while in the emergency department, but also the resources for patients to maximize the impact of this care once they leave the department. The Patient Advocacy Subcommittee hopes that our growing list of patient education brochures contributes to an arsenal of interventions that strengthen the quality of the care we deliver and its outcomes.

If your hospital already has an EHR with printable discharge instructions, you may see no use for additional materials. However, many of these materials exceed the reading comprehension levels of the average patient. Stossel et al explored patient education materials (PEMs) from Micromedex, EBSCO, and MedlinePlus who supply PEMs to Meditech- a popular EHR supplier- and the National Library of Medicine. These results showed that anywhere from 30%-100% of 100 disease-matched PEMs from these databases were written above 8th grade reading levels when evaluated using[3] validated indices.[5] The average US resident reads at or below an 8th grade level. So, if you have ideas for future brochure topics and/or patient education ideas, we’d love to hear from you! info@aaemrsa.org/ Advocacyrsa14@list.aaem.org

Current brochures available at http://www.aaemrsa.org/resources/patient-and-discharge-resources

A. Resources for Antibiotic Use

B. Why Don’t I Have a Clear Diagnosis?

C. Medication Safety: Tips for Parents & Seniors

D. Resources for Mental Health: How to Find the Help You Need

E. Guide to Pain Medication: What You Need to Know

F. Resources for Alcohol Abuse and Alcoholism

G. Being Safe at Home – Domestic Violence

H. Advanced Directive and POLST: Have the Discussion

I. Roadmap to to Your Emergency Visit


References

1. Farnsworth M. Differences in Perceived Difficulty in Print and Online Patient Education Materials. The Permanente Journal 2014;18(4):45-50. doi:10.7812/TPP/14-008.
   
2. Engel KG. Knowledge Deficits at ED Discharge. Physician’s Weekly. April 2013. Available at: http://www.physiciansweekly.com/ed-discharge-knowledge-deficits/. Accessed: March 24, 2014.
   
3. Engel KG, Buckley BA, McCarthy DM, et al. Communication amidst chaos: challenges to patient communication in the emergency department. J Clin Outcomes Manag. 2010;17:4. - See more at: http://www.physiciansweekly.com/ed-discharge-knowledge-deficits/#sthash.mDDUbiLU.dpuf
   
4. Stewart MA. Effective physician-patient communication and health outcomes: a review. CMAJ: Canadian Medical Association Journal 1995;152(9):1423-1433.
   
5. Stossel LM, Segar N, Gliatto P, Fallar R, Karani R. Readability of Patient Education Materials Available at the Point of Care. Journal of General Internal Medicine 2012;27(9):1165-1170. doi:10.1007/s11606-012-2046-0.

Financial disclosures: The author(s) have no potential conflicts of interest to disclose.