Emergency Department Intervention

Ahmed H, Baker A, Cox C, Gary C, Geer B, Mojoko E, Muhammad-Harris K, Patel J
Doctor of Medicine Candidates, Morehouse School of Medicine

During a typical emergency department (ED) visit, a patient is attended to, stabilized and acute symptoms are treated. Upon discharge, the patient may receive medication and/or further self-care instruction which providers usually assume are understood.  The questions remaining include whether the patient was only stabilized to possibly return again with the same complication, or if the care staff adequately and appropriately explained the discharge instructions, leaving the patient with knowledge addressing prevention of future visits.  These are the questions our project aims to address. With diverse experiences in the ED, members of our team noticed that there was a gap between the treatment a patient received in the emergency department and the patient’s understanding of their individualized treatment plan.  Patient understanding is key to preventing similar presentations to the ED after they are discharged, as demonstrated in several published studies.  Recognizing this discrepancy, we endeavored to establish an intervention that would identify and address some of the underlying reasons for noncompliance, resulting in recurrent ED visits.

There are many reasons for these return visits.  Of particular interest in the literature is the literacy level of the patients, which may affect their understanding of their medications and their written and verbal discharge instructions.  It is our intention, through this brief research and service-learning opportunity, that we better understand how health literacy affects the rate of return visits to the emergency room and attempt to prevent some of these recurrences by educating patients about disease processes, prevention and treatment.

The project is designed to be carried out by 3rd year medical students in their family medicine rotation at the Morehouse School of Medicine.  This will allow the class to contribute to a community service project, while fulfilling the mission of the school.  We hope this project can continue indefinitely, providing students with an opportunity for continued service learning, while providing Grady Memorial Hospital a staff of students to assist in the health literacy and compliance of emergency room patients.  These students will enroll patients with asthma, hypertension, and diabetes related morbidities and provide informational pamphlets related to each illness.  Students will focus on education to prevent disease complications from occurring, as well as disseminating information concerning insurance resources and other methods of payment.  Discharge instructions given by the emergency physician will also be reviewed with the patients to ensure that maximum understanding is achieved.

In order to test the efficacy of our intervention, pre- and post-intervention surveys will be administered to the patients to gauge the understanding of their condition, discharge instructions, and disease process.  The purpose of surveying the population is to determine if the intervention has added to the patients’ understanding of their plans, thereby potentially preventing complications that would result in additional ED visits.

The emergency room, for many patients, serves as a primary care provider. This places the heavy burden on emergency physicians and nurses of striking the balance between acutely managing patients and providing adequate counseling for prevention of long-term complications.  The ultimate goal of this project is to enhance the communication between doctors and patients in the Emergency Department in order to minimize repeat visits by patients due to noncompliance or poor understanding of their discharge treatment plan.   Our intervention aims to educate and verify patients’ understanding of their discharge instructions prior to leaving the ED in order to improve the health services provided by the Grady Memorial Hospital Emergency Department.

Filed Under: Lifestyles

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About the Author: publications@snma.org

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