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Communicating More Effectively at ED Discharge

Emergency physicians face unique challenges in providing high-quality care due to distractions and time limitations that are common throughout ED settings. In most cases, emergency physicians have little or no previous knowledge of the patients they see. According to Margaret E. Samuels-Kalow, MD, MPhil, effective communication is paramount when patients are discharged from the ED, but this element is often overlooked. “Discharge communication is often an afterthought in the ED,” she says. “We’re limited to brief exchanges of forms and prescriptions, leaving patients with uncertainty about their care plan and increasing their risks for more health issues down the line.” Further complicating matters is that many patients and families who arrive at EDs have limited health literacy, do not speak English, or have had difficult experiences with the healthcare system. “These types of patients are at risk for being discharged from the ED without comprehending instructions from emergency personnel,” says Dr. Samuels-Kalow. Seizing Communication Opportunities Effective discharge communication provides an opportunity for emergency personnel to summarize patient visits and teach them how to safely care for themselves at home, Dr. Samuels-Kalow says. “It also gives ED physicians a chance to address any remaining questions or concerns. We can help connect patients to providers who can best manage their needs after discharge. Focused interactions with nurses and physicians are opportunities for education during the entire ED stay.” In the August 2012 Annals of Emergency Medicine, Dr. Samuels-Kalow and colleagues published a review that discussed the roles of content, delivery, comprehension, and implementation in identifying patient understanding of ED discharge instructions (Table 1). “It’s imperative that instructions are complete and understandable...

Weekend Vs Weekday Admissions for AF

A review of more than 86,000 discharges with a primary diagnosis of atrial fibrillation (AF) sug­gests that patients admitted on weekends appear to be less likely to undergo a cardioversion procedure and more likely to die resulting from AF when compared with patients admitted on weekdays. Cardioversion procedures were performed in 7.6% of AF patients during weekend admissions, compared with 16.2% for those being admitted during weekdays. The in-hospital mortality odds ratio was 1.23 for AF patients admitted during weekends. Abstract: American Journal of Cardiology, July 15,...
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