Do patients understand discharge instructions?

INTRODUCTION: Adherence to aftercare instructions following an emergency department visit may be essential for facilitating recovery and avoiding complications, but conditions for teaching and learning are less than ideal in the ED. The objective of this study was to identify and describe areas of patient confusion about ED discharge instructions. METHODS: Follow-up telephone calls were made to 50 ED patients on the day after discharge to inquire how they were doing and whether they had any questions about their instructions. RESULTS: Fifteen subjects (31%) requested information about their aftercare instructions that required further clarification by the investigator, and 15 subjects (31%) described a diagnosis-related concern that revealed poor comprehension of instructions. DISCUSSION: This study demonstrated that patients commonly remain confused about aftercare information following treatment in an ED. Follow-up telephone calls may be useful for identifying and addressing ongoing learning needs.

Diagnostic blood loss in mechanically ventilated patients.

BACKGROUND: Concern for the volume of blood loss resulting from diagnostic phlebotomy has been expressed in the literature for decades. Blood conservation strategies have been found to reduce the volume withdrawn for laboratory tests, but some patient populations may remain at risk. OBJECTIVE: This study examines the frequency of phlebotomy and volume of diagnostic blood loss for critically ill mechanically ventilated patients in a small community hospital. METHODS: The subjects were 43 critically ill adults who received mechanical ventilation for at least 24 hours during the first quarter of 2005. Data were collected from computerized medical records and included the frequency and types of laboratory tests performed over the course of hospitalization. RESULTS: The mean total number of blood samples withdrawn was 69 (standard deviation = 59). The mean amount withdrawn per day was 16 mL (standard deviation = 7) with mean total volumes ranging from 57 to 1120 mL per patient. Four patients had more than 500 mL withdrawn. Chemistry analyses accounted for both the highest frequency of phlebotomy and the highest volume. CONCLUSIONS: The daily volume of diagnostic blood loss for this population was less than the amounts previously reported in the literature, so there is some evidence of effectiveness of blood conservation strategies. However, some patients were still experiencing blood loss as the result of phlebotomy that may have been clinically significant. Additional strategies for reducing phlebotomy volumes are recommended.