The Impact of Teach-Back Method on Retention of Key Domains of Emergency Department Discharge Instructions

Abstract

BackgroundStudies have shown that patient understanding and recall of their emergency department (ED) discharge instructions is limited. The teach-back method involves patients repeating back what they understand, in their own words, so that discharge providers can confirm comprehension and correct misunderstandings. ObjectiveThe objective of this study was to determine if the teach-back method would increase retention of post ED discharge instructions. MethodsA before-and-after study design (pre and post teach-back method) was used at an academic Midwestern institution. After discharge, patients were asked a set of standardized questions regarding their discharge instructions via telephone interview. Answers were compared with the participant's discharge instructions in the electronic medical record. A composite score measuring mean percent recall correct was calculated in four categories: diagnosis, medication reconciliation, follow-up instructions, and return precautions. Data were collected for 1 week prior to and 1 week post intervention. One additional week between the pre- and postintervention phases included training and practice behavior adoption. The primary outcome was mean percent recall correct between the two groups assessed by a Mann-Whitney U test, and adjusted for confounders with an analysis of covariance model. ResultsThe mean percent recall correct in the teach-back phase was 79.4%, or 15 percentage points higher than the preintervention group. After adjusting for age and education, the adjusted model showed a recall rate of 70.0% pre vs. 82.1% (p < 0.005) post intervention. ConclusionsThe teach-back method had a positive association on retention of discharge instructions in the ED regardless of age and education.