A Call for a Better Discharge Instruction Forms for TBI Patients
As an attorney representing individuals with acquired mild traumatic brain injury, it is not unusual to review emergency room reports which contain only a cursory examination looking for signs or symptoms of brain injury. Even when a diagnosis of mild TBI or concussion is made, patients are often given confusing follow-up instructions with regard to the need for future medical care.
I was recently reading an excellent article in Brain Injury, the official journal of the International Brain Injury Association, entitled A Proposal for an Advanced-Based Emergency Department Discharge Form for Mild Traumatic Brain Injury. This proposal written by Fung, Willer, Moreland and Leddy of the Department of Family Medicine, University of New York, Buffalo. The authors examined and compared a sample of head injury care instruction forms which were provided in various hospital emergency room departments against evidence-based factors predictive of hemorrhage or traumatic lesions. Based on their study they have proposed an easy to understand discharge instruction form for patients with concussion or mild traumatic brain injury.
According to the authors, "Most emergency room departments provide discharge information forms or brochures to patients with head injuries. The discharge instruction forms generally present a list of symptoms the patients may experience after a concussion. However, there are no standards or guidelines for these information forms" and the authors are concerned that critical information for monitoring the patient might be left out. The purpose of the study was to examine a sample of discharge information forms from a sample of hospitals and compare them to critical signs and symptoms of hemorrhage that the best evidence in the literature says should be observed.
As the authors correctly note, patient discharge instruction forms "are important because the potential for neurologic deterioration after seemingly minor brain injury." The authors found that the wording on most discharge summaries were "vague" and that if the instruction forms "were intended to instruct family members on what to look for in case the injured person developed a hemorrhage then virtually all of the instruction forms were inadequate." The authors concluded that a discharge instruction sheet should be easy to read and easy to understand. The authors reviewed various clinical risk factors for predicting structural intracranial lesions after MTBI and concluded that information forms distributed by hospital emergency rooms use "current and relevant information to instruct family members on signs and symptoms after MTBI". The authors recommended that the optimum readability of discharge instructions be at a grade six level and recommended a minimum font size of 12.
Brain Inj. 2006 Aug; 20 (9):889-94