BMJ Qual Saf doi:10.1136/bmjqs-2011-000538
  • Original research

Older veterans and emergency department discharge information

  1. Kenneth Schmader2,3,4
  1. 1Center for Health Services Research in Primary Care, Veterans Affairs Medical Center, Durham, North Carolina, USA
  2. 2Geriatrics Research, Education and Clinical Center, Veterans Affairs Medical Center, Durham, North Carolina, USA
  3. 3Division of Geriatrics, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
  4. 4Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina, USA
  5. 5Department of Health Policy and Management, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA
  6. 6Division of General Internal Medicine, Veterans Affairs Medical Center, Durham, North Carolina, USA
  1. Correspondence to Dr Susan Hastings, HSR&D, MC 152, Durham VAMC, 508 Fulton Street, Durham, NC 27705, USA; hasti003{at}
  1. Contributors All persons designated as authors qualify for authorship according to ICMJE guidelines. Individual contributions were as follows: study concept and design (SH, KS, EO, MW and KS), acquisition of data (SH, KS, DT and WK) and analysis and interpretation of data (SH, KS, EO, MW and KS); drafting the article or revising it critically for important intellectual content (all); and final approval of the version to be published (all).

  • Accepted 12 April 2012
  • Published Online First 3 May 2012


Background Study goals were to assess older veterans' understanding of their emergency department (ED) discharge information and to determine the association between understanding discharge information and patient assessment of overall quality of care.

Methods Telephone interviews were conducted with 305 patients aged 65 or older (or their proxies) within 48 h of discharge from a Veterans Affairs Medical Center ED. Patients were asked about their perceived understanding (at the time of ED discharge) of information about their ED diagnosis, expected course of illness, contingency plan (ie, return precautions, who to call if it got worse, potential medication side effects) and follow-up care. Overall quality of ED care was rated on a four-point scale of poor, fair, good or excellent.

Results Patients or their proxies reported not understanding information about their ED diagnosis (21%), expected course of illness (50%), contingency plan (43%), and how soon they needed to follow-up with their primary care provider (25%). In models adjusted for age and race, a positive association was observed between perceived understanding of the cause of the problem (OR 2.3; 95% CI 1.3 to 4.0), expected duration of symptoms (OR 1.6; 95% CI 1.0 to 2.5) and the contingency plan (OR 2.2; CI 1.3 to 3.4), and rating overall ED care as excellent.

Conclusions Older veterans may not understand key items of information at the time ED discharge, and this may have an impact on how they view the quality of ED care. Strategies are needed to improve communication of ED discharge information to older veterans and their families.


  • The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs. Portions of this work were presented at the VA Health Services Research and Development Annual Meeting in National Harbor, Maryland on 17 February 2011 and the Annual Scientific Meeting of the American Geriatrics Society in National Harbor, Maryland on 12 May 2011.

  • Funding This research was conducted while Dr Hastings was supported by a VA Health Services Research and Development Career Development Award (CD 06-019) and Dr Weinberger was supported by a VA Health Services Research Senior Career Scientist Award (RCS 91-408). The authors also received support from the Durham VA Center for Health Services Research in Primary Care and the Durham VA Geriatrics Research, Education and Clinical Center.

  • Competing interests None.

  • Ethics approval This study was approved by Durham VAMC IRB.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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