Abstract:
STUDY OBJECTIVE:To be able to adhere to discharge instructions after a visit to the emergency department (ED), patients should understand both the care that they received and their discharge instructions. The objective of this study is to assess, at discharge, patients' comprehension of their ED care and instructions and their awareness of deficiencies in their comprehension. METHODS:We conducted structured interviews of 140 adult English-speaking patients or their primary caregivers after ED discharge in 2 health systems. Participants rated their subjective understanding of 4 domains: (1) diagnosis and cause; (2) ED care; (3) post-ED care, and (4) return instructions. We assessed patient comprehension as the degree of agreement (concordance) between patients' recall of each of these domains and information obtained from chart review. Two authors scored each case independently and discussed discrepancies before providing a final concordance rating (no concordance, minimal concordance, partial concordance, near concordance, complete concordance). RESULTS:Seventy-eight percent of patients demonstrated deficient comprehension (less than complete concordance) in at least 1 domain; 51% of patients, in 2 or more domains. Greater than a third of these deficiencies (34%) involved patients' understanding of post-ED care, whereas only 15% were for diagnosis and cause. The majority of patients with comprehension deficits failed to perceive them. Patients perceived difficulty with comprehension only 20% of the time when they demonstrated deficient comprehension. CONCLUSION:Many patients do not understand their ED care or their discharge instructions. Moreover, most patients appear to be unaware of their lack of understanding and report inappropriate confidence in their comprehension and recall.
journal_name
Ann Emerg Medjournal_title
Annals of emergency medicineauthors
Engel KG,Heisler M,Smith DM,Robinson CH,Forman JH,Ubel PAdoi
10.1016/j.annemergmed.2008.05.016subject
Has Abstractpub_date
2009-04-01 00:00:00pages
454-461.e15issue
4eissn
0196-0644issn
1097-6760pii
S0196-0644(08)00831-7journal_volume
53pub_type
杂志文章abstract::Cardiac arrest caused by massive pulmonary embolism is highly refractory to conventional resuscitation. Emergency surgical embolectomy has been considered the only effective intervention. We present the case of a 33-year-old woman who suffered a massive pulmonary embolism with circulatory arrest refractory to one half...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(89)80527-x
更新日期:1989-06-01 00:00:00
abstract:STUDY OBJECTIVE:We sought to characterize the clinical manifestations, outcome, and etiology of inadvertent ketamine overdose in the emergency department. METHODS:We investigated cases of inadvertent ketamine overdose in children seen in the ED solicited through electronic mail subscription lists or reported to the In...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,多中心研究
doi:10.1016/s0196-0644(99)80051-1
更新日期:1999-10-01 00:00:00
abstract::Clinical presentations and pathogeneses of endocarditis and aspects of its diagnosis and management relevant to emergency department practice are reviewed. Guidelines for admission, laboratory evaluation, and decisions regarding the initiation of therapy in the ED are offered. Also discussed are the role of the emerge...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,评审
doi:10.1016/s0196-0644(05)81663-4
更新日期:1991-04-01 00:00:00
abstract::This multiorganizational literature review was undertaken to provide an evidence base for determining whether or not recommendations for out-of-hospital termination of resuscitation could be made for children who are victims of traumatic cardiopulmonary arrest. Although there is increasing acceptance of out-of-hospita...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,实务指引,评审
doi:10.1016/j.annemergmed.2014.01.013
更新日期:2014-04-01 00:00:00
abstract::The ingestion of iron-containing products is a potential toxicologic emergency. The total iron binding capacity (TIBC) has been used widely as a predictor of end-organ toxicity and a guide to the need for deferoxamine therapy. When the TIBC is greater than the serum iron concentration (SIC), it is held that no free ir...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,评审
doi:10.1016/s0196-0644(99)70420-8
更新日期:1999-01-01 00:00:00
abstract:STUDY OBJECTIVE:The relationship between tiredness and medical errors is now commonly accepted. The main objective of this study is to evaluate the cognitive performance of emergency physicians after a night shift of 14 hours (H14) and after a work shift of 24 hours (H24) and to compare it with tests performed after a ...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2017.10.005
更新日期:2018-08-01 00:00:00
abstract:STUDY OBJECTIVE:In 2001, less than 20% of emergency medicine residents had more than $150,000 of educational debt. Our emergency medicine residents anecdotally reported much larger debt loads. Surveys have reported that debt affects career and life choices. Qualitative approaches are well suited to explore how and why ...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2016.04.013
更新日期:2016-10-01 00:00:00
abstract:STUDY OBJECTIVE:Studies of travel-related mortality and morbidity have been limited to nonfatal events. Causes of travel-related mortality may differ significantly from morbidity and thus have different prevention strategies. DESIGN:We examined the overseas fatalities of US citizen travelers for the years 1975 and 198...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(05)82379-0
更新日期:1991-06-01 00:00:00
abstract:STUDY OBJECTIVE:We compare laryngoscopy performance and overall intubation success in trauma airways when primary airway management alternated between emergency medicine and anesthesia residents on an every-other-day basis. METHODS:Data on all trauma intubations during approximately 3 years were prospectively collecte...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(03)00638-3
更新日期:2004-01-01 00:00:00
abstract:STUDY OBJECTIVE:We assess the prognostic role of initial glucose levels in patients with a first acute myocardial infarction in the emergency department (ED). METHODS:We conducted a 3-year retrospective cohort study. Patients with a first acute myocardial infarction were recruited from the ED of a tertiary hospital fr...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2006.10.023
更新日期:2007-05-01 00:00:00
abstract:STUDY OBJECTIVE:We compare test characteristics of abdominal computed tomography (CT) with and without oral contrast for identifying intra-abdominal injuries. METHODS:This was a planned subanalysis of a prospective, multicenter study of children (<18 years) with blunt torso trauma. Children imaged in the emergency dep...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,多中心研究
doi:10.1016/j.annemergmed.2015.01.014
更新日期:2015-08-01 00:00:00
abstract::Blunt abdominal trauma is a common presentation to the emergency department. Ischemic colitis is a rare complication of this and its possible sequelae are important for an emergency physician to recognize. A 21-year-old man presented to the emergency department with abdominal pain and hourly episodes of bright red blo...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2011.01.014
更新日期:2011-08-01 00:00:00
abstract::The epidemiology of pediatric fever has changed considerably during the past 2 decades with the development of vaccines against the most common bacterial pathogens causing bacteremia and meningitis. The decreasing incidence of these 2 conditions among vaccinated children has led to an emphasis on urinary tract infecti...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,评审
doi:10.1016/j.annemergmed.2012.10.034
更新日期:2013-05-01 00:00:00
abstract:STUDY OBJECTIVE:Urinary catheters are often placed in the emergency department (ED) and are associated with an increased safety risk for hospitalized patients. We evaluate the effect of an intervention to reduce unnecessary placement of urinary catheters in the ED. METHODS:Eighteen EDs from 1 health system underwent t...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2014.02.013
更新日期:2014-06-01 00:00:00
abstract::We present the cases of three patients with preexisting bundle-branch block in whom wide-complex tachycardias were considered to be of supraventricular origin because QRS morphologies were essentially unchanged from those during normal sinus rhythm. The patients experienced adverse effects from medications for suprave...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(95)70245-8
更新日期:1995-07-01 00:00:00
abstract::Presented is a case of syncope as the initial sign of a painless aortic dissection. The patient was stabilized by percutaneous drainage of a hemopericardium, and then underwent angiography and successful operative repair. Although uncommon, painless aortic dissection should be included in the differential diagnosis of...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(84)80528-4
更新日期:1984-07-01 00:00:00
abstract:STUDY OBJECTIVES:To determine why emergency department patients leave without being seen by a physician and whether they receive alternate medical care. DESIGN:A prospective, cross-sectional study of patients who left without being seen. Charts were reviewed for population demographics, presenting complaints, and clin...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(94)70238-1
更新日期:1994-12-01 00:00:00
abstract:STUDY OBJECTIVE:More than 1,000 patients experience sudden cardiac arrest each day. Treatment for this includes cardiopulmonary resuscitation (CPR_ and emergency medical services (EMS) that provide CPR-basic life support (BLS), BLS with defibrillation (BLS-D), or advanced life support (ALS). Our previous systematic rev...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:
更新日期:1999-10-01 00:00:00
abstract:STUDY OBJECTIVE:Aeromedical crews offer an advanced level of practice and rapid transport to definitive care; however, their efficacy remains unproven. Previous studies have used relatively small sample sizes or have been unable to adequately control for the effect of other potentially influential variables. Here we ex...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2005.01.024
更新日期:2005-08-01 00:00:00
abstract:STUDY OBJECTIVE:I evaluate the variation in requirements for informed consent in studies evaluating chemical tranquilization of agitated patients. METHODS:A computer-assisted literature search of the National Library of Medicine was performed. Additional use of the references listed in the articles identified with the...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2005.08.025
更新日期:2006-01-01 00:00:00
abstract::Reported is a case of a 34-year-old man, previously in good health, who underwent chiropractic manipulation of the cervical spine for treatment of a recent whiplash injury. Immediately following manipulation, the patient became unresponsive and was found to have sustained a brain stem infarction resulting in the "Lock...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(83)80217-0
更新日期:1983-10-01 00:00:00
abstract:STUDY OBJECTIVE:In recent years, air transport of patients has been associated with disproportionate increases in crashes and deaths. We identify factors related to fatal outcome in air medical helicopter crashes and suggest preventive measures. METHODS:This was a retrospective study using National Transportation Safe...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2005.11.018
更新日期:2006-04-01 00:00:00
abstract:STUDY OBJECTIVE:We determine the validity of self-reported prescription filling among emergency department (ED) patients. METHODS:We analyzed a subgroup of 1,026 patients enrolled in a randomized controlled trial who were prescribed at least 1 medication at ED discharge, were covered by Medicaid insurance, and complet...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.annemergmed.2013.01.026
更新日期:2013-09-01 00:00:00
abstract:STUDY OBJECTIVE:We assess the prevalences of bacterial meningitis and herpes simplex virus meningoencephalitis (HSV-ME) in children with a complex febrile seizure and determine these prevalences in the subgroup of children with a clinical examination result not suggestive of meningitis or encephalitis. METHODS:This mu...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,多中心研究
doi:10.1016/j.annemergmed.2016.11.024
更新日期:2017-07-01 00:00:00
abstract::We developed a cardiopulmonary resuscitation (CPR) message that can be given via telephone by emergency dispatchers directly to an individual reporting a cardiac arrest. The message was developed and evaluated on the basis of empirical observation of CPR performance of 203 community volunteers during simulated cardiac...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(84)80730-1
更新日期:1984-09-01 00:00:00
abstract::To assess the relationship between conjunctival pH (pHcj), arterial pH (pHa), and cardiorespiratory variables during normal and low-flow conditions, hemorrhagic hypotension was induced in eight dogs. Conjunctival pH became significantly less than control values after a hemorrhage volume of 15 mL/kg (P less than .05); ...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(85)80630-2
更新日期:1985-09-01 00:00:00
abstract::Many patients seeking care in the modern emergency center are capable of participating in treatment decision making. In the traditional emergency center consent process, the patient or a surrogate is asked to sign a general consent form purporting to authorize any treatment the emergency physician deems necessary. We ...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(87)80289-5
更新日期:1987-01-01 00:00:00
abstract::The efficiency of cross clamping the thoracic aorta for cases of massive hemorrhage and impending cardiac arrest is questionable. We present two cases of major intra-abdominal aortic injury in which the bleeding could not be controlled by cross clamping the thoracic aorta. Multiple collateral pathways around the clamp...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(82)80241-2
更新日期:1982-03-01 00:00:00
abstract::Cocaine use and abuse continue to overwhelm urban economic, social, and health care systems. Patients frequently present to the emergency department with life-threatening manifestations of cocaine use, including trauma, acquired immune deficiency syndrome, psychomotor agitation, and cardiovascular collapse. Adequate t...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,评审
doi:10.1016/s0196-0644(05)81217-x
更新日期:1991-02-01 00:00:00
abstract::Test strips recently have become available to measure theophylline levels. One such test strip (AccuLevel) had not been tested in an actual clinical situation with nontechnician personnel. We prospectively evaluated the test strip on consecutive emergency department patients, comparing it with the agglutination inhibi...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(88)80440-2
更新日期:1988-10-01 00:00:00