Assessing the Efficacy of Emergency Department Discharge Instructions

Discharge instructions are an integral part of communication in the Emergency Department (ED). However, rigorous studies assessing the quality of ED discharge instructions are scarce, and dedicated instruments are lacking. The objective of this study was to evaluate the quality of critical aspects of ED discharge instructions.

This cross-sectional study included 100 patients discharged from a single academic medical center over 10 consecutive days in October 2025. Clinician-formulated discharge instructions (found on the After Visit Summary [AVS] in Epic) were scored; each chart was reviewed by 2 individuals independently. A previously developed instrument was adapted for the ED setting (Quality of Discharge Instructions-Inpatient, Austad et al). The domains evaluated were: Primary Diagnosis, Self-Management Instructions, Return Precautions, Recommended Follow-up, Outstanding Results, Incidental Findings, Medication Changes, and Standardized Instructions. A Likert scale was used, from 1 (Very Poor) to 4 (Very Good). Readability was assessed using the Flesch Reading Ease Score (FRES) and Flesch-Kincaid Grade Level (FKGL).

98 charts had a signed AVS and were included. Of the domains that applied to all charts, the median [IQR] score for Primary Diagnosis was 3 [3,4], Self-Management Instructions was 3 [1, 4], Return Precautions was 4 [3, 4], and Recommended Follow-up was 3 [3, 4]. There were Outstanding Results in 15.3% of charts, with a median score of 1.5 [1, 4]. Incidental Findings were present in 12.8% of charts, with a median score of 1 [1, 1]. Medication Changes were present in 36.7% of charts, with a median score of 3 [2, 4]. Standardized instructions were present in 45.9% of charts, with a median rating of 4 [4, 4]. The mean (± SD) FRES was 53.2 ± 12.0, consistent with “fairly difficult”, and the mean FKGL was 9.4 ± 3.5. 92.3% of instructions were provided in the patient’s preferred language.

We identified high performing domains (Return Precautions) and low performing domains (Self-Management Instructions, Outstanding Results, and Incidental Findings). Most patients received instructions in their preferred language, but the readability scores were suboptimal. This pilot study reflects the initial development of an ED-specific instrument and may inform targeted interventions to improve the quality of discharge communication.