Authors

1. Haatainen, Kaisa PhD
2. Tervo-Heikkinen, Tarja PhD
3. Saranto, Kaija DSc.

Abstract

Review question/objective: The objective of this review is to critically appraise and synthesize the best available evidence based on primary studies exploring adult patients' experiences of discharge education in an emergency department in order to address the following question: "What are the experiences of adult patients' related to their discharge education from the emergency department?"

Background: Discharging patients from the hospital is a complex process with many challenges. When patient discharge is well planned and timed, the quality of life for the patient may be improved, as well as the financial well-being of healthcare systems.1,2 The number of emergency department (ED) visits is already high and growing. For instance in the US, 19.6% of adults (aged 18 years and over) in 1997 and 20.3% of adults in 2011 had one or more ED visits within the past 12 months, and 6.7% in 1997 and 7.3% in 2011 in the same age group had two or more visits.3

Patient turnover in the ED is rapid so the time for patient education per patient can be extremely short. However, a patient always needs to receive adequate guidance so that he or she understands and is able to follow the doctor's and nurse's advice to handle their illness or condition at home.4 Comprehensive discharge instructions are necessary to ensure a smooth transition from hospital to home, as the responsibility for care shifts from healthcare providers to the patient and caregivers. Unfortunately, patients often go home without understanding critical information about their hospital stay, such as their discharge diagnosis or medication changes5, leaving them both dissatisfied with their discharge instructions6 and at risk for hospital readmission.7 Patient education is the process of informing a patient about a health matter to secure informed consent, patient cooperation and a high level of patient compliance.8 Some studies have raised the need for standardized discharge education for patients in different disease groups in the ED, such as patients with head-injuries or asthma.9,10

Discharge planning means the development of an individualized discharge plan for the patient prior to leaving the hospital, to ensure that patients are discharged at an appropriate time and with provision of adequate post-discharge services. At the time of discharge, the patient should be provided with a document that includes language and literacy-appropriate instructions and patient education materials to help in successful transition from the hospital. These documents should be brief, focusing on critical information relevant to the patient and primarily directed at what the patient needs to understand to manage his/her condition after discharge.11

Many studies have shown that patient education needs are different in older age and older citizens and that their relatives need more time and effort from care providers to support the older patients' coping at home.12,13,14 Patient education faces new challenges as the relative proportion of older people and patients increases.13

A patient with sufficient information about their condition and with solid patient education has good possibilities to participate in his or her own care.15 Patient education benefits can be seen in 1) increasing the patient's ability to cope with and manage his/her health; 2) facilitating patients' and families' understanding of their health status, options and consequences of care; 3) empowering patients in decision making; 4) increasing patients' potential to follow the healthcare plan; 5) helping patients' learn behaviors, promoting recovery and improving function; 6) increasing patient confidence in his/her self-care; and 7) decreasing treatment complications.15 Besides valuable benefits to the patient, healthcare organizations that provide targeted and appropriate patient and family education can reap benefits. Patient education can increase customer satisfaction, improve compliance with regulatory standards and efficiency through cost-effective care and also leads to better informed patients, thus lessening the chance of malpractice claims.15

In addition, relatives need regular informing and education to be able to act as caregivers after discharge. They can be too shy to ask for advice or more anxious than the patient themself.16 Staff should ensure that there are no unclear issues, for example regarding medication instructions or limitations on dietary and physical exercise, for a patient when leaving the ED.17

Several systematic reviews on patient education will be published in the Joanna Briggs Institute (JBI) and Cochrane databases in the near future. Fredericks and Yau will review studies which concentrate on the educational interventions for adults to prevent readmission and complications following cardiovascular surgery.18 The others will review the effectiveness of discharge interventions19, structured discharge process20 and patient-caregiver dyad discharge interventions.21 This systematic review, however, will concentrate on adult patients' experiences of discharge education in the ED. Discharge education refers to written or verbal education that the patient has received prior to discharge.