II. Precautions
- Discuss Discharge Instructions with every patient
- Patients often do not understand their Discharge Instructions
- Document that provider verbally reviewed Discharge Instructions
- Document that questions were answered and the patient understands the discharge plan
- Engel (2012) Acad Emerg Med 19(9): E1035-44 +PMID:22978730 [PubMed]
- Do not rely solely on generic or pre-printed Discharge Instructions (or on pharmacy pre-printed information)
- Pre-printed instructions may offer no benefit over written instructions
- Lawrence (2009) Pediatr Emerg Care 25(11):733-8 +PMID:19864969 [PubMed]
- Discharge Instructions should be specific
- Return instructions for red flag symptoms, worsening or new, concerning symptoms
- Medication additions, discontinuations and precautions
- Express diagnostic uncertainty
- Most conditions (e.g. Chest Pain, Abdominal Pain, febrile illness, Joint Pain) have a broad differential diagnosis
- Emergency and acute care focus on decreasing the probability of serious conditions to make discharge home safe
- However, patients should be aware, that serious causes are almost never 100% excluded
- Encourage patients to keep recommended follow-up and to not hesitate to return for new or changing symptoms
- Follow-up
- Follow-up within what time frame and with which provider
- Follow-up should be appropriate for the condition
- RLQ Abdominal Pain recheck should be within 24 hours
- Low Risk Chest Pain with consideration for stress testing should be within 72 hours
- Follow-up should be within a reasonable time frame
- Patients are unlikely to be able to schedule close-interval follow-up (1-2 days) by themselves
- If follow-up is needed within 1-2 days, then facilitate the follow-up
III. References
- Delaney in Herbert (2016) EM:Rap 16(10): 5-6
- Weinstock and Calvert in Herbert (2019) EM:Rap 19(10): 8-9
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| Concepts | Health Care Activity (T058) |
| English | patient instructions, instructions for patient, patient instructions (treatment) |
Ontology: hospital discharge instructions (treatment) (C2266673)
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| LNC | LP101193-3, MTHU036254 |
| English | hospital discharge instructions, hospital discharge instructions (treatment), discharge instructions, Discharge instructions |
Ontology: Discharge instructions:Find:Pt:{Setting}:Doc:{Provider} (C3669312)
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