care Multimedia instruction also offers other advantages over traditional instruction, including the capability for asynchronous learning, customizable interactive content based on the needs of the patient and family, multimedia presentation to overcome literacy or language barriers, and optimization of content and presentation based on feedback using web diagnostics Other approaches, such as text messaging patients and families after ED discharge, have been associated with increased compliance with medications, and follow-up Adolescent patients may even prefer receiving discharge instructions by email or text along with printed instructions Combination Method: The Preferred Method Optimal discharge instructions combine written and verbal instructions and include pictures when relevant Including pictures as visual cues can help to improve recall Drawing pictures demonstrating the correct dosing of pediatric suspension medications may be particularly important The addition of verbal reinforcement, especially in the patient/guardian’s preferred language, may further solidify understanding of the information, while at the same time satisfying the family’s desire to have a final interaction with their care provider The provision of discharge instructions needs to be a two-way conversation, allowing the family to ask questions, and engaging them with methods such as Ask Me or TeachBack that enhance and assess their understanding OBSTACLES TO COMPREHENSION AND RETENTION OF DISCHARGE INSTRUCTIONS There are several obstacles to effective discharge instruction Up to half of patients receiving discharge instructions were not aware they had, in fact, received them Patients/parents may not even read the discharge instructions provided Often the medical provider does not review all key components of discharge instructions Even after review with a medical provider, there is variable retention of that material, and many families leaving the ED are unable to fully recall discharge information Engel et al evaluated patient understanding of discharge instructions across five domains: diagnosis, medications, home care, follow-up, and return instructions Two-thirds of discharged patients showed minimal or no understanding in at least one of the domains evaluated, with a deficit of