How Discharge Instructions Affect the Patient Experience

emergency_room[1]A Case in point

Thanks to a recent trip to my local emergency room for upper respiratory problems, I experienced first-hand the crucial role that clear, personalized discharge instructions play in a patient’s recovery, as well as in the overall care experience. Upon arriving in ER late one night, my local hospital’s very personal, capable ER staff moved me from triage through diagnoses and treatment with efficiency and care. They swiftly relieved my pain and fear, running multiple tests and treating my issues with thorough professionalism and alacrity; in fact, I returned home to my own bed within 2.5 hours of departing for the hospital!

That’s when my grateful admiration turned to disappointment, coloring my entire view of my ER experience. My discharge instructions, an integral part of my recovery at home, proved to be quite long, vague at best, and not even specific to my case. I received ten pages of generic instructions that amounted to an automatic printout of garbled words, with no input from my diligent ER doctor. They did not even address me, but “you and your child.” Really? As the paying patient, I was offended by such carelessness, not to mention frustrated and confused by the instructions. They blatantly contradicted the “core measures” commitment printout that the hospital eagerly handed me earlier. Talk about disillusioning.

I had to call the hospital’s busy ER staff the next morning for clarification on my treatment. I took the opportunity to connect with the ED Director, relating how my wonderful patient experience was ruined by the substandard, generic discharge instruction. She shared with me that they didn’t get to consider or vote on their discharge instructions and that they were “just built in” to their EMR. ER departments across the country strive to deliver fast, accurate, compassionate care, while improving efficiency and patient/family satisfaction. Why ruin that effort with the one lasting imprint a patient takes home and relies upon?

MF, a patient who recently visited an emergency room in the Chicago area


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5 Responses to How Discharge Instructions Affect the Patient Experience

  1. Chris Galassi, MD says:

    Hospitals do have a choice about what discharge instructions they use. Meaningful, patient-specific discharge instructions do make a difference. Just to be clear, the hospital where this patient received care was not using Discharge 1-2-3 discharge instructions.

  2. Stephanie, RN says:

    As a registered nurse I couldn’t agree more. The discharge instructions I give a patient must be clear and to the point, specific to their treatment and easy for them to understand. It’s crucial that the instructions are a patient-specific tool as opposed to a long, vague educational piece that they won’t read. Stephanie, RN.

  3. Connie says:

    Couldn’t agree more…no matter what application is being used by a provider (regardless of setting) there is an opportunity for the ‘client’ (provider) to work with the vendor and their IT depts. on many levels: care plans, discharge plan; patient education and instructions. There are many terrific ‘packaged instructions’ that often be integrated into a system.
    But the discharge instructions for the patient, especially from the ER must be patient specific – and there are ways to do just that. No matter how great the care, as soon as the patient leaves the dept, if the instructions are poor..the risk of a return are huge.

  4. The experience of this patient is, sadly, common. In fact, in a report called ???Snapshot of People???s Engagement in Their Health Care??? published by The Center For Advancing Health, we learn that 91 percent of patients leaving hospital with a chronic illness diagnosis did NOT receive a written plan of care when they were discharged from the hospital – not even that uselessly inappropriate 10 pages of “you and your child” garble described here. More at:

    This is a no-brainer. Of course EDs have a choice, and to claim that hospital staff are somehow being forced to hand out garbage is insulting, particularly with existing re-admission rate concerns.

  5. As a professional healthcare advocate, 23 years in practice has directed me on a specialty path. I work as a Hospitalization and Discharge Specialist. You would not believe how busy I am. Just the idea of releasing patients without their prescriptions being filled is a disaster waiting to happen in so many instances. I’ve never had a client readmitted within 30 days of discharge for the same condition. There’s a reason why. A successful discharge process requires one-on-one personalized care with the patient. And as for those unable to afford a service such as this, I, as well as many others in my field, work on a sliding scale and pro bono basis.

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