Improving Communication with Patients Discharged from the Emergency Department with Noncardiac Chest Pain: A Scoping Review with Narrative Synthesis

Table 1

Items guiding discharge communication with patients presenting to the emergency department with chest pain.

#	Items
Initial assessment
1	Assessments should take place in quiet and private places/sides. Privacy and confidentiality of the patients should be respected.
2	Healthcare providers should greet and introduce themselves to patients and/or their accompanying attendants. In all cases, patients and their accompanying attendants should be treated with dignity and respect.
3	Medical history should be taken using open-ended questions with appropriate prompts whenever needed to clarify/probe for something.
4	Healthcare providers should spend sufficient time during history taking and physical examination.
5	Patients should be encouraged to talk more about their health complaints.
6	Healthcare providers should listen attentively while patients explain their complaints.
7	All forms of interruptions should be avoided or at least minimized.
8	Efforts should be made to avoid overutilization of emergency department.
Information on diagnosis
1	Healthcare providers should explain to the patients and/or their accompanying attendants that the cardiovascular, pulmonary, and blood circulation systems were carefully examined.
2	Healthcare providers should inform the patients and/or their accompanying attendants that all the investigations had ruled out myocardial infarction at this time.
3	Healthcare providers should inform the patients and/or their accompanying attendants about the potential diagnosis.
4	Healthcare providers should explain to the patients and/or their accompanying attendants the course of the disease.
5	Healthcare providers should explain to the patients and/or their accompanying attendants the potential complications of the disease.
6	Healthcare providers should reassure the patients and/or their accompanying attendants.
7	Healthcare providers should spend sufficient time providing information to the patients and/or their accompanying attendants.
Information on discharge
1	Healthcare providers should notify the patients that they are ready to be discharged home.
2	Healthcare providers should give discharge instructions to the patients and/or their accompanying attendants.
3	Healthcare providers should give both written and verbal instructions to the patients and/or their accompanying attendants.
4	Healthcare providers should provide nonmedical instructions like avoiding stress, taking rest, etc.
5	Healthcare providers should provide self-care instructions like quitting smoking, eating healthy diet, adherence to regular exercise, control of other comorbidities like hypertension and diabetes, etc., if present.
6	Healthcare providers should ask the patients and/or their accompanying attendants if they have more unanswered questions.
7	Healthcare providers should make sure that the patients and/or their accompanying attendants understood the information provided.
8	Healthcare providers should make sure that the patients and/or their accompanying attendants are satisfied with the discharge information.
9	Healthcare providers should determine if the diagnosis and discharge information can be correctly recalled by the patients and/or their accompanying attendants immediately after discharge.
Follow-up suggestions
1	Healthcare providers should inform the patients and/or their accompanying attendants what further investigations are still or will be needed.
2	Healthcare providers should explain to the patients and/or their accompanying attendants the reasons why further investigations are still or will be needed.
3	Healthcare providers should inform the patients and/or their accompanying attendants when and where the investigations can be done.
4	Healthcare providers should explain specific instructions related to the needed investigations like if the patient should come fasting, fed, etc.
5	Healthcare providers should advise the patients to consult/follow up with their family/community physicians after discharge.
6	Healthcare providers should inform the patients when and how to follow up.
7	Healthcare providers should inform the patients that 24-hour telephone contact is possible for follow-up in case needed.
Symptoms that prompt return to the emergency department
1	Healthcare providers should inform the patients that returning to the emergency department is an option when necessary.
2	Healthcare providers should inform the patients that they should return to the emergency department if their chest pain lasted for more than 10 minutes.
3	Healthcare providers should explain to the patients specific red flags that need earlier review visit like fever, focal neurological deficit, sweating, etc.
4	Healthcare providers should inform the patients to return to the emergency department in case of chest pain that is radiated to jaw or arms.
5	Healthcare providers should inform the patients to return to the emergency department if they have difficulty breathing.
6	Healthcare providers should inform the patients to return immediately to the emergency department if they started to complain of chest pain that did not respond to nitroglycerin.
7	Healthcare providers should inform the patients that the emergency department is always open and they can come back anytime, even at night, during weekends, and holidays.
Treatment plan
1	Healthcare providers should inform the patients that the treatment has to start without any delay.
2	Healthcare providers should tell the patients the name of prescribed medication (acetyl-salicylic acid, beta-blockers, nitroglycerin, etc.).
3	Healthcare providers should tell the patients the dose of the prescribed medication that they should take.
4	Healthcare providers should tell the patients the frequency of the prescribed medication at which they should take.
5	Healthcare providers should tell the patients when to take the prescribed medication in relation to meals.
6	Healthcare providers should tell the patients the potential adverse reactions that could be associated with the prescribed medication and how to cope with them.
7	Healthcare providers should tell the patients what to avoid when taking the prescribed medications and how to make the best out of them.