Overlooking Barriers to Safe and Effective Emergency Department Discharge.

Area of Science:

• Emergency Medicine
• Health Services Research
• Patient Care

Background:

• Physician awareness of patient social and functional barriers post-emergency department (ED) discharge is critical for safe care.
• Limited data exist on resident physicians' ability to identify these post-discharge barriers.

Purpose of the Study:

• To evaluate the ability of emergency medicine (EM) resident physicians to identify patient barriers to care after ED discharge.
• To compare patient-reported barriers with those identified by EM residents.

Main Methods:

• Prospective cohort study in an urban ED with an EM residency program.
• Patients (≥18 years) assessed for barriers (transportation, medication costs, ADL assistance, PCP access).
• Health literacy and cognitive function measured; patient-reported barriers compared to resident surveys using Cohen's kappa.

Main Results:

• Patients reported barriers more frequently than physicians identified them.
• Low sensitivity for resident identification of barriers: PCP access (26.1%), health literacy (44.7%), cognitive impairment (27.3%).
• Significant agreement gaps observed between patient reports and resident assessments.

Conclusions:

• Patients report significantly more barriers to post-ED care transitions than EM residents identify.
• Poor agreement underscores the need for enhanced resident training, systematic screening protocols, and interdisciplinary collaboration to address patient needs.