Do Patients Understand Their Discharge Instructions?
Date First Published:
November 29, 2025
Last Updated:
November 29, 2025
Report by:
Emma Syrek DO, Christian Kolacki MD, Senior EM resident, EM Faculty (Corewell Health/Michigan State University Emergency Medicine Residency Program)
Search checked by:
Jeffrey Jones MD, Research Director
Three-Part Question:
Do [adult patients discharged from the emergency department] [fully comprehend] their [written discharge instructions]?
Clinical Scenario:
A 34-year-old comes to the ED with one day of abdominal pain with mild anorexia but no fevers. Pain is well controlled with IV medication in the ED and CT of the abdomen and pelvis shows possible developing appendicitis. The patient would like to go home since he is feeling better, and as you discuss return precautions and appropriate follow-up care. You wonder how best to provide discharge instructions to ensure the patient understands your advice.
Search Strategy:
Medline 1966-10/25 using PubMed, Cochrane Library (2025), and Embase
Search Details:
(Discharge instructions) AND (emergency service). Limit to adults and English language
Outcome:
136 articles were found, three meta-analyses addressed the clinical question.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Patient Discharge Instructions in the Emergency Department and Their Effects on Comprehension and Recall of Discharge Instructions: A Systematic Review and Meta-analysis. Hoek AE, Anker SCP, van Beeck EF, et al. March 2020 Netherlands | 5,314 ED patients who were discharged home; 1460 received verbal instructions, 3,395 received written instructions, 459 received video instructions. | Systematic review with meta-analysis of 18 RCTs and 33 observational studies to provide an overview of the different manners of providing discharge instructions in the emergency department (ED) and to assess their effects on comprehension and recall. | Comprehension and recall of discharge instructions after the ED visit. | Correct recall of verbal, written, and video discharge instructions ranged from 8% to 94%, 23% to 92%, and 54% to 89%, respectively. Pooled data showed differences in correct recall, with, on average, 47% for patients who received verbal information, 58% for patients who received written information, and 67% for patients who received video information. | Heterogeneity in patient-population-related and patient-related factors, such as low health literacy or language barriers, may have contributed to the wide variation in correct recall of discharge instructions. Other factors influencing recall of information may also be present in different levels for each patient; for example, emotional state during education, preexisting health status, and amount of information. |
| Scoping Review of Adult Emergency Department Discharge Interventions Gorlick MK, Balasubramanian S, Han G, et al. July 2025 USA | 100 studies reporting on ED-based discharge interventions in adults | A scoping, summative review of adult ED discharge interventions to date, evaluating the literature for potential best practices and future directions. | What adult ED discharge interventions exist, and which are most effective | The authors summarized ED discharge intervention themes to form seven subgroups: mode of discharge, additional resource provision, addition of a discharge coordinator, follow-up assistance, pharmaceutical intervention, patient-centered education, and clinician/discharger-centered education. | The majority os studies were retrospective cohort studies with few RCTs or prospective study designs and high variability of methodologies and outcome measures. A formal assessment of the included article and abstract quality or risk of bias was not conducted. Limited to studies written in English. |
| Effective strategies included enhanced discharge discussions and education by dedicated personnel, structured discharge checklists, and delivery of instructions at an appropriate reading level. | |||||
| The authors summarized ED discharge intervention themes were summarized to form seven subgroups: mode of discharge, additional resource provision, addition of a discharge coordinator, follow-up assistance, pharmaceutical intervention, patient-centered education, and clinician/discharger-centered education. | |||||
| Discharge instruction comprehension by older adults in the emergency department: A systematic review and meta-analysis Haimovich AD, Mulqueen S, Carreras-Tartak J, et al. November 2024 USA/UK | 1,760 patients ages 60+ who were discharged from the ED | Systematic review and meta-analysis to identify discharge comprehension gaps amenable to future interventions. | Comprehension of: diagnosis, self-care, medications, routine follow-up, and return precautions | Patients had significantly better comprehension of diagnosis (85%), self-care (81%) and routine follow-up (76%) than medication instructions (41%). Return precaution comprehension varied widely (35% - 71%). | Impacts on at-risk populations specifically were not considered, significant variability among clinician-provided instructions, and results cannot be applied to more complicated discharge instructions. |
Author Commentary:
The three systematic reviews each have their limitations; specifically, small sample size, variability in methods of measuring a patient’s understanding of their instructions, variability in the way instructions were provided (combination verbal and written, free text and standardized vs one or the other), and consideration of at-risk populations. Despite these limitations, instructions about return precautions were often poorly understood, and comprehension would benefit from standardized instructions written at a 6th-grade reading level or lower. Patients may require a multimodal approach to receiving ED discharge instructions. Video may be useful in some cases.
Bottom Line:
Written, standardized instructions should be used when possible for patients being discharged from the emergency department because they improve patients’ understanding of their instructions, especially in regards to follow up, duration of illness, and indications to return to the ED. Medication instructions should be explicitly and simply stated, particularly in the geriatric population.
Level of Evidence:
Level 1: Recent well-done systematic review was considered or a study of high quality is available
References:
- Hoek AE, Anker SCP, van Beeck EF, et al.. Patient Discharge Instructions in the Emergency Department and Their Effects on Comprehension and Recall of Discharge Instructions: A Systematic Review and Meta-analysis.
- Gorlick MK, Balasubramanian S, Han G, et al.. Scoping Review of Adult Emergency Department Discharge Interventions
- Haimovich AD, Mulqueen S, Carreras-Tartak J, et al.. Discharge instruction comprehension by older adults in the emergency department: A systematic review and meta-analysis