Internal and Emergency Medicine

, Volume 14, Issue 1, pp 133–138 | Cite as

Barriers to compliance with emergency department discharge instructions: lessons learned from patients’ perspectives

  • Erica Schenhals
  • Paul Haidet
  • Lawrence Edward KassEmail author


The objective of this study is to understand patients’ perspectives about system-based barriers that may influence decision-making regarding following discharge instructions. In this qualitative study, subjects were interviewed by phone 1–4 weeks following being discharged to home from the emergency department (ED). We used a semi-structured interview guide to ask a series of open-ended questions about subjects’ recent ED visit and subsequent course, including discharge instructions, whether or not they complied with those instructions, and reasoning behind their decisions to follow-up or not. All interviews were recorded and transcribed to identify themes among the transcripts, which were analyzed to identify barriers to compliance. While the majority of those interviewed expressed no specific concerns or challenges, four system-based themes did emerge regarding patient attitudes toward and experiences with discharge instructions. They were: (1) failure to ensure clarity about diagnosis at the time of discharge from the ED, (2) failure to identify patients’ feelings of hopelessness regarding the utility of follow-up, (3) difficulty in scheduling follow-up appointments, and (4) the importance of a clear discharge process. This study finds several system-based barriers might influence compliance. The four identified themes suggest a recurring cycle of visiting the ED, being discharged to primary care or specialists, and ultimately returning to the ED. We propose that systems-based interventions may help to break this cycle.


Patient compliance Emergency department Qualitative study 



The authors would like to thank Nancy Campbell, RN, and her research project team for the assistance in the planning and conduction of this study.

Compliance with ethical standards

Conflict of interest

The authors have no potential conflicts of interest.

Human and animal rights statement

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Società Italiana di Medicina Interna 2018

Authors and Affiliations

  1. 1.Department of Emergency MedicineThe Pennsylvania State University College of MedicineHersheyUSA
  2. 2.Department of MedicineThe Pennsylvania State University College of MedicineHersheyUSA
  3. 3.Department of HumanitiesThe Pennsylvania State University College of MedicineHersheyUSA
  4. 4.Department of Public Health SciencesThe Pennsylvania State University College of MedicineHersheyUSA
  5. 5.The Woodward Center for Excellence in Health Sciences EducationThe Pennsylvania State University College of MedicineHersheyUSA

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