Comprehension of discharge instructions by patients in an urban emergency department.

Study Objective: To assess patients' comprehension of their emergency department discharge instructions and to determine if inner-city patients' literacy levels are adequate to comprehend written discharge instructions.
Design: Prospective, observational study.
Setting: The ED of an inner-city university hospital.
Participants: Two hundred seventeen patients consecutively discharged from the ED during 12 separate time slots.
Interventions: Patients were interviewed after discharge from the ED and asked to state their diagnosis, medication instructions, and follow-up instructions. Comparisons between patient recall and instructions as written in the chart were assessed by independent raters and scored from poor to excellent. Patients were administered a standardized test of reading ability.
Results: Overall comprehension rates were judged to be good, although 23% of patients exhibited no understanding of at least one component of their discharge instructions. Mean reading ability of the patients was at the sixth-grade level. The ED's printed discharge instructions were written at an 11th-grade reading level. Patients with low literacy scores were more likely to have poor comprehension of instructions.
Conclusion: Overall comprehension rates in this population were good despite the fact that ED instruction sheets were written at an inappropriately high reading level. Verbal instructions given by the discharging physician likely have a significant effect on patients' comprehension of instructions.