Emergency department discharge instructions: a wide variation in practice across Australasia

Abstract

Objectives—All patients discharged from the emergency department (ED) should be given discharge instructions (DIs). This study aimed to describe the DI practices of EDs in Australasia and to examine the differences between public and private EDs. Methods—A voluntary, questionnaire-based survey of public and private EDs throughout Australia and New Zealand. Results—58 of 74 (78.4%) EDs provided instruction notes upon discharge although 51 (68.9%) gave them to only “some” patients. There were no significant differences between the public and private EDs (p>0.05). Thirty seven (50%) EDs provided pre-formatted instruction sheets although 22 (29.7%) EDs gave them to only “some” patients. There were no significant differences between the public and private EDs (p>0.05). Only five (6.8%) EDs retained a copy of the instruction sheets and no (0%) ED provided sheets that included all recommended features. Sixty six (89.2%) EDs provided information sheets although 44 (59.5%) EDs gave them to only “some” patients. Private EDs gave information sheets to significantly more patients than public EDs (p=0.04). Conclusions—The DI practices of individual EDs varied and the rates of DI provision were low. EDs should improve their DI practices. Pre-formatted instruction sheets, containing all recommended features, should be provided to all patients with a copy kept in the medical record. Consideration should be given to the use of DI practices as an ED performance indicator.