Medical malpractice often occurs at the time of discharge. A recent study published in the Academic Emergency Medicine journal showed that many patients do not understand discharge instructions that are given at the conclusion of their hospital admission. The study was performed by having nurses interview English-speaking patients within 48 hours of a hospital discharge to assess the patients’ understanding of their discharge instructions. Results showed alarming deficits in understanding important instructions pertaining to home care (80%), when to return to the hospital (79%), medications (22%) and diagnosis (14%).
Every year at Mishkind Kulwicki Law, we investigate medical negligence cases that arise out of faulty discharge instructions. These cases have involved contradictory instructions given by the attending physician and the discharge nurse, the failure to re-start medications that were temporarily stopped during the hospital admission (two cases), failure to followup on abnormal test results, and the failure to alert patients to important signs or symptoms that required the patient to return to the emergency department.
Many factors contribute to problems at discharge. Given health insurers’ insistence on shorter and shorter hospital stays, patients are being discharged with greater levels of acuity than ever before. As medicine becomes more complex and treatment more specialized, discharge instructions naturally become more difficult to understand. Consider also that the patient population is aging as Americans live longer. Older patients may be less capable of understanding or remembering complicated discharge instructions. Put these factors together with the bewilderment that commonly accompanies discharge, especially for patients that are in pain or not fully recovered from anesthesia, and you can see why discharge is ripe for medical errors.
Medical malpractice occurs when healthcare providers fall below accepted standards of care. But what if the standard of care is to stick a set of preprinted, one-size-fits-all discharge instructions into your hand and then wheel you to the curb with no further followup? Preprinted discharge instructions are apt to overwhelm a patient and go unread, not assist in post-discharge care and recovery. Hospitals seem content to load these forms up with useless information, most likely supplied by their legal department to use as a defense later, rather than focusing the patient on critical information.