CHAPTER 133 ■ INSTRUCTIONS FOR PARENTS HILARY A HEWES, NANETTE C DUDLEY DISCHARGE INSTRUCTIONS Discharge instructions are an integral part of the emergency department (ED) experience Well-designed instructions serve as a summary of the ED course and a reference for ongoing medical management by the patient and outpatient care provider In addition, review of instructions at discharge offers a final opportunity for a patient to clarify any questions or concerns about care received or the follow-up plan Information given to the patient and family needs to be provided in an understandable and retainable manner Lack of comprehension of discharge instructions may lead to problems with compliance, incorrect use of medication, inadequate treatment and follow-up, and ultimately negative patient outcomes LEGAL AND REGULATORY CONSIDERATIONS The Centers for Medicare and Medicaid Services (CMS) measures specific elements in the transition record at hospital discharge Although obviously not specific to ED care, these recommendations can be adapted to ED discharge instruction content: Discharge diagnosis Procedures and tests performed, with significant findings, and any pending tests Medications prescribed/changes to medications, reasons for medication Patient and family instructions Reasons to follow up with primary care provider or specialist and reasons to return to the ED Follow up physician’s name, specialty, and contact information Meaningful Use Beginning in 2011, the CMS initiated a voluntary financial incentive plan for the “meaningful use” of certified electronic health record technology by