The impact of teach-back on comprehension of discharge instructions and satisfaction among emergency patients with limited health literacy: A randomized, controlled study

Abstract

Objective

Recommended as a ‘universal precaution’ for improving provider–patient communication, teach-back has a limited evidence base. Discharge from the emergency department (ED) to home is an important high-risk transition of care with potential for miscommunication of critical information. We examined whether teach-back improves: comprehension and perceived comprehension of discharge instructions and satisfaction among patients with limited health literacy (LHL) in the ED.

Methods

We performed a randomized, controlled study among adult patients with LHL, randomized to teach-back or standard discharge instructions. Patients completed an audio-recorded structured interview evaluating comprehension and perceived comprehension of (1) diagnosis, (2) ED course, (3) post-ED care, and (4) reasons to return and satisfaction using four Consumer Assessment of Healthcare Providers and Systems questions. Concordance with the medical record was rated using a five-level scale. We analyzed differences between groups using multivariable ordinal logistic regression.

Results

Patients randomized to receive teach-back had higher comprehension of post-ED care areas: post-ED medication (P < 0.02), self-care (P < 0.03), and follow-up instructions (P < 0.0001), but no change in patient satisfaction or perceived comprehension.

Conclusion

Teach-back appears to improve comprehension of post-ED care instructions but not satisfaction or perceived comprehension. Our data from a randomized, controlled study support the effectiveness of teach-back in a busy clinical setting. Further research is needed to test the utility and feasibility of teach-back for routine use including its impacts on distal outcomes.

Keywords:

• Emergency department
• Health literacy
• Intervention studies
• Physician–patient relations
• Teach-back communication

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Errata

Acknowledgements

The authors would like to acknowledge Ralph O'Neil for assistance with technology procurement, programing, database management, and data retrieval and William Macmillan for assistance in preparation for data analysis.

Additional information

Notes on contributors

Richard T. Griffey

Richard T. Griffey, MD, MPH, is Associate Chief and Director of Patient Safety and Quality in the Division of Emergency Medicine at Washington University School of Medicine and is a Coursemaster and Scholar in the Washington University Institute for Public Health. His work focuses on patient safety, quality measurement and quality improvement, health literacy and communication and evidence-based imaging.

Nicole Shin

Nicole Shin is a fourth year medical student at the Washington University School of Medicine.

Solita Jones

Solita Jones is a fourth year medical student at Meharry Medical College in Nashville, TN. Her interests are in health disparities and barriers to accessing care, preventative healthcare and public and global health.

Nnenna Aginam

Nnenna V. Aginam is a fourth year Medical Student at Meharry Medical College in Nashville, TN and a Magna Cum Laude graduate of Towson University in Baltimore, Maryland. She plans to pursue residency training in Emergency Medicine.

Maureen Gross

Maureen Gross, MD, is in her fourth year at Washington University Emergency Medicine Residency at Barnes-Jewish Hospital where she will be commencing a fellowship in sports medicine.

Yonitte Kinsella

Yonitte Kinsella, MD, PhD, is in her fourth year at Washington University Emergency Medicine Residency at Barnes-Jewish Hospital.

Jennifer A. Williams

Jennifer A. Williams, PhD, RN, ACNS-BC, is the Clinical Nurse Specialist in the Department of Emergency Services at Barnes-Jewish Hospital. Dr. William's areas of focus are sepsis, emergency nursing competency development and public health.

Christopher R. Carpenter

Chris Carpenter, MD, MSc, is an Associate Professor and Director of Evidence Based Medicine in the Division of Emergency Medicine at Washington University in St. Louis, a Fellow of the American College of Emergency Physicians the American Geriatrics Society, and on the Editorial Boards of Academic Emergency Medicine, ACP Journal Club, and the Journal of the American Geriatrics Society. His research interests include diagnostics, dementia, falls prevention, and implementation science.

Melody Goodman

Melody Goodman, PhD, is an Assistant Professor in the Division of Public Health Sciences, Department of Surgery at Washington University School of Medicine. Dr. Goodman's areas of focus are biostatistics, health disparities, community engaged research and minority and medically underserved populations.

Kimberly A. Kaphingst

Kimberly A. Kaphingst, ScD, is a Professor of Communication and Investigator at the Huntsman Cancer Institute at the University of Utah. Dr. Kaphingst's areas of research focus are health literacy and risk communication.