II. Precautions

  1. Discuss Discharge Instructions with every patient
    1. Patients often do not understand their Discharge Instructions
    2. Document that provider verbally reviewed Discharge Instructions
    3. Document that questions were answered and the patient understands the discharge plan
    4. Engel (2012) Acad Emerg Med 19(9): E1035-44 +PMID:22978730 [PubMed]
  2. Do not rely solely on generic or pre-printed Discharge Instructions (or on pharmacy pre-printed information)
    1. Pre-printed instructions may offer no benefit over written instructions
    2. Lawrence (2009) Pediatr Emerg Care 25(11):733-8 +PMID:19864969 [PubMed]
  3. Discharge Instructions should be specific
    1. Return instructions for red flag symptoms, worsening or new, concerning symptoms
    2. Medication additions, discontinuations and precautions
  4. Express diagnostic uncertainty
    1. Most conditions (e.g. Chest Pain, Abdominal Pain, febrile illness, Joint Pain) have a broad differential diagnosis
    2. Emergency and acute care focus on decreasing the probability of serious conditions to make discharge home safe
    3. However, patients should be aware, that serious causes are almost never 100% excluded
    4. Encourage patients to keep recommended follow-up and to not hesitate to return for new or changing symptoms
  5. Follow-up
    1. Follow-up within what time frame and with which provider
    2. Follow-up should be appropriate for the condition
      1. RLQ Abdominal Pain recheck should be within 24 hours
      2. Low Risk Chest Pain with consideration for stress testing should be within 72 hours
    3. Follow-up should be within a reasonable time frame
      1. Patients are unlikely to be able to schedule close-interval follow-up (1-2 days) by themselves
      2. If follow-up is needed within 1-2 days, then facilitate the follow-up

III. References

  1. Delaney in Herbert (2016) EM:Rap 16(10): 5-6
  2. Weinstock and Calvert in Herbert (2019) EM:Rap 19(10): 8-9

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