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Better instructions needed in Emerg: study

TORONTO - Patients who are discharged from a hospital emergency department sometimes have a poor understanding of how they should care for themselves once they get home, says a new review of more than 50 studies.

TORONTO - Patients who are discharged from a hospital emergency department sometimes have a poor understanding of how they should care for themselves once they get home, says a new review of more than 50 studies.

In an article published in January's Annals of Emergency Medicine, researchers recommend that doctors provide instructions verbally, in writing and with a visual demonstration whenever possible.

"It doesn't happen as systematically as I would want it to," said one of the co-authors, Dr. Stephen Porter of the Hospital for Sick Children in Toronto.

In pediatrics, for example, he said a lot of medications come in liquid form. Only a minority of parents can figure out a complex dosing question without help, but doctors don't necessarily show each patient exactly the dose that needs to be given.

Physicians talk in terms of the dose in milligrams, but that has to be translated by the parent at home into a volume amount in a syringe, Porter explained.

One small study of elderly patients found 21 per cent didn't understand their diagnosis at discharge.

Another study in a pediatric emergency department found that although almost half the parents had a high school education or less, five out of seven discharge instructions required college-level reading skills. Only 30 per cent of parents were able to demonstrate both an accurately measured and correct dose of acetaminophen, according to another study.

"One of the big lessons for a lot of institutions is that simply giving written instructions, especially if it's not at a reading level that is appropriate for a given patient, doesn't really help," Porter said Tuesday from Mont-Tremblant, Que., where he was attending a conference.

"Because there's not going to be much on that piece of paper that's going to be a real reference for people if they either don't understand what's written or if they don't have somebody else who can work with the document and understand what the plan is."

The message for families from this review is that it is "absolutely appropriate and good for them to ask questions ... and ask for people to show them," he said.

At this time of year, he said the hospital is seeing a lot of children with coughs and colds, and babies who are congested, which makes it difficult for them to eat.

"We spend a lot of time these days in Emerg teaching parents how to safely suction out their baby's nose, just so it's easier for them to breastfeed. A lot of parents aren't necessarily taught how to do that, and that's one of those things that helps their baby feel better."

The review, which covered both pediatric and adult discharges from emergency departments, involved researchers at Toronto SickKids and Children's Hospital Boston.

 
 
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