Older adults discharged from the ED demonstrated 41% comprehension of medication instructions (95% CI 31%-50%), which was lower than comprehension for self-care (81%) and routine follow-up (76%).
Meta-Analysis
What is the proportion of older adults comprehending emergency department discharge instructions across different domains?
Older adults discharged from the ED have poor comprehension of medication instructions compared to self-care and follow-up, highlighting a priority area for intervention.
Abstract Introduction Older adults are at high risk of adverse health outcomes in the post–emergency department (ED) discharge period. Prior work has shown that discharged older adults have variable understanding of their discharge instructions which may contribute to these outcomes. To identify discharge comprehension gaps amenable to future interventions, we utilize meta‐analysis to determine patient comprehension across five domains of discharge instructions: diagnosis, medications, self‐care, routine follow‐up, and return precautions. Methods Using Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines, two reviewers sourced evidence from databases including Medline (PubMed), EMBASE, Web of Science, CINAHL, and Google Scholar (for gray literature). Publications or preprints appearing before April 2024 were included if they focused on geriatric ED discharge instructions and reported a proportion of patients with comprehension of at least one of five predefined discharge components. Meta‐analysis of eligible studies for each component was executed using random‐effects modeling to describe the proportion of geriatric ED cases understanding the discharge instructions; where appropriate we calculated pooled estimates, reported as percentages with 95% confidence interval (CI). Results Of initial records returned ( N = 2898), exclusions based on title or abstract assessment left 51 studies for full‐text review; of these, seven constituted the study set. Acceptable heterogeneity and absence of indication of publication bias supported pooled estimates for proportions comprehending instructions on medications (41%, 95% CI 31%–50%, I 2 = 43%), self‐care (81%, 95% CI 76%–85%, I 2 = 43%), and routine follow‐up (76%, 95% CI 72%–79%, I 2 = 25%). Key findings included marked heterogeneity with respect to comprehending two discharge parameters: diagnosis ( I 2 = 73%) and return precautions ( I 2 = 95%). Conclusions Older patients discharged from the ED had greater comprehension of self‐care and follow‐up instructions than about their medications. These findings suggest that medication instructions may be a priority domain for future interventions.
Haimovich et al. (Thu,) conducted a meta-analysis in Emergency department discharge. Emergency department discharge instructions was evaluated on Proportion comprehending instructions on medications (95% CI 31%-50%). Older adults discharged from the ED demonstrated 41% comprehension of medication instructions (95% CI 31%-50%), which was lower than comprehension for self-care (81%) and routine follow-up (76%).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: