Davee News and Events

September 2011: Congratulations to Barbara Buckley, who recieved the 2011 Annual ENA Conference Poster Award for Research while representing our department's Davee research team at this year's Emergency Nurses' Association conference in Tampla, Florida.

Literacy-based and Patient-guided Enhancement of Emergency Department Discharge Process

September 2009. Identified 5 sets of common ED diagnosis specific instructions.

5 diagnoses were chosen based on either the complexity of the diagnosis, multiple medications indicated for treatment, complicated homecare instructions and/or follow-up.

Back pain
Kidney Stone
Head Injury
Laceration repaired with sutures or staples
Ankle sprain

September 2009 to May 2011. Development of the 5 diagnosis specific ED discharge instructions

This rigorous process began in September of 2009 and continued into 2011. A multidisciplinary team of healthcare professionals, literacy experts, medical illustrators and patients worked together to develop discharge instructions that not only were accurate in content, but would actually improve patient comprehension and there by improve patients out comes.

November 2009. ED survey distribution with staff input to key concepts of each diagnosis
January 2010. Expert panel review of survey results
February 2010. Literature Review for content accuracy
February 2010. Subspecialist review
- Neurosurgery
- Orthopedics
- Sports medicine
- Plastics
- Urologist
- Literacy expert
April 2010. Lexile analysis to ensure readability at 6^th-8^th grade level
June 2010. Focus groups at FQHC to gather patient input to instructions
- 3 sessions, each session focusing on 1-2 of the diagnosis specific instructions
June 2010. Illustrator utilized to develop drawings to assist patients in understanding diagnosis and key concepts
December 2010. Graphic designer was brought in to enhance the visual appeal of the instructions
May 2011. Final instructions launched in the ED

March 2010- Current. Nurse Liaison patient comprehension phone interviews

Nurses known for their excellent communication skills and expertise in emergency medicine were recruited to perform patient interviews by phone 24-36 hours post-discharge to evaluate patient understanding of diagnosis, homecare, medications, follow-up and reasons to return to the ED.

159 patients who received current standard of care
Redeploy late spring/summer 2011 for additional 160 patients for evaluation of new instructions developed by research team

August 2010- May 2011. Patient preference pilot survey comparing existing instructions to newly developed instructions

The goal of this pilot was to determine patient preference of the discharge documents that currently exist compared to the newly developed model. In addition we asked the patients to identify words or statements that were difficult for them to understand. Finally, patients were asked to identify the things they needed to do to take care of their problem at home and reasons they should return to the ED.

100 patients in Feinberg Mezz Obs or ED Mezz
Patients who evaluated our newly designed instructions were 3 times as likely to be able to correctly identify the things they needed to do to take care of their problem at home and reasons they should return to the ED.

May 2010 Ongoing. Manuscripts

Several in Process
Published
- Journal of Clinical Outcomes Management, October 2010: Communication Amidst Chaos: Challenges to Patient Communication in the Emergency Department

Review of Emergency Discharge Processes

January 2010. Survey distributed to ED’s nationally to obtain current patient specific discharge instructions, policies and procedures

The goal of this survey is to determine key elements found in patient specific ED discharge instructions and uncover policies and procedures to define best practices and paperwork to utilize at ED discharge.

40 respondents
Research team identified key components found on review of patient specific instructions to assist in the development of enhanced patient specific instructions