Ginde et al Hospitalization and Discharge Education of Emergency Department Patients With

The purpose of this study is to evaluate the content and adequacy of emergency department (ED) discharge instructions and factors associated with hospitalization in patients presenting with hypoglycemia. Methods This is a retrospective cohort study at 3 adult EDs. A 1-year consecutive sample of hypoglycemia cases were identified using ICD-9-CM codes and were confirmed by chart review. Clinical variables and written discharge instructions were analyzed by chart abstraction. Results Six hundred thirty-six charts of patients with possible hypoglycemia were reviewed, of which 436 (64%) hypo-glycemia cases were confirmed. The median age was 64. Hypoglycemia was associated with sulfonylurea use for 78 (16%) patients and insulin alone for 286 (65%) patients. Written discharge instructions advised frequent blood glucose checks in 21 % of patients and medication dose adjustment in 27 % of patients and rarely recom-mended avoiding recurrent hypoglycemia (3%), check-ing glucose before driving (0.4%), or obtaining glucagon emergency kits (2%). Hospitalization resulted from 177 (41%) visits and was associated with older age (age 65-74 [odds ratio 5.7] and age ≥75 [odds ratio 7.9]), sul-fonylurea use (odds ratio 3.5), ≥3 hypoglycemic episodes (odds ratio 3.1), no documented diabetes medication