Discharge communication in the emergency department : on quantity- and content-definition and on the benefit of information structuring

Health and diseases have always accompanied humans and are important topics to talk about. Appropriate communication, however, can only have an impact on one’s health if the essential content is transferred and if the message is sent in a way enabling the receiver to understand and recall it. Therefore, this cumulative dissertation has been realized to conduct four studies focusing on the quantity and content of information conveyed from the physician to the patient in the emergency department as perceived by both parties involved and in this context on the benefit of information structuring on the receiver’s subsequent recall capacity. Through the preliminary study, we could show that physicians from different specialties defined a large number of items as necessary to be given to a patient with chest pain at discharge from the emergency department. Study 1 revealed that physicians and patients strongly overlap in their assessment of what ought to be conveyed in a discharge communication: Nearly all items identified by the majority of physicians as important were also endorsed by the majority of patients. Three expert physicians classified the items chosen by the two groups into five exclusive categories, namely “Information on diagnosis”, “Follow-up suggestions”, “Advices on self-care”, “Red flags”, and “complete Treatment”, from which we generated the mnemonic acronym “InFARcT”. As experimentally tested in study 2 (using students as proxy patients), information structuring proofed to be beneficial in terms of the recall capacity of students with little to no prior medical knowledge: students in the structured condition recalled mean 8.12 items, whereas students in the non-structured condition recalled mean 5.71 items (p=0.004). Assuming that structure should benefit mostly those individuals who cannot make use of previous knowledge to build memory chunks and to better control the experimental setup between the two parameters “structure” and “prior knowledge”, we set out to oppose various degrees of relevant prior knowledge to structured and non-structured content presentation in study 3, with the following results: prior medical knowledge boosted recall performance – the group of students with the least prior knowledge recalled fewer items (M=7.11) than the group of students with intermediate prior knowledge (M=9.49), who in turn recalled fewer items than the group of students with most prior knowledge (M=13.23). Furthermore, the magnitude of the effects of information structuring seems to vary systematically by the degree of medical knowledge: It is greatest with least prior knowledge, and disappears gradually with increasing expertise. We conclude that there is an obvious need to train physicians in skills of implementing effective discharge communication, in content and form, as this represents a valuable and rare opportunity to communicate, and thereby to foster better outcomes. It should not go to waste