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Anaya M, Law W, Montoya HL, Moreira CM. Discharge Interventions for Limited English Proficiency Patients: A Scoping Review. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02003-2. [PMID: 38639867 DOI: 10.1007/s40615-024-02003-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 03/30/2024] [Accepted: 04/07/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Limited English proficiency patients are required under federal law to receive language-concordant care, yet they still receive substandard discharge instructions compared to English-speaking patients. We aimed to summarize the interventions carried out to improve discharge instructions in the limited English proficiency population. METHODS We conducted a scoping review of academic and gray literature from the United States using Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols for Scoping Reviews guidelines. We searched PubMed, Embase, and CINAHL for studies to improve discharge communication. RESULTS Of the 3330 studies, 19 studies met the criteria. Core types of interventions included written interventions alone, educational interventions alone, written and educational interventions, audio and visual interventions, and other types of interventions. Even among the same core types of interventions, there were differences in types of interventions, outcomes examined, and results. DISCUSSION The majority of included interventions that studied satisfaction as an outcome measure showed improvement, while the other outcomes were not improved or worsened. More rigorous methodology and community involvement are necessary to further analyze discharge interventions for patients with limited English proficiency (LEP).
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Affiliation(s)
- Melanie Anaya
- The Warren Alpert Medical School, Brown University, 222 Richmond Street, Providence, RI, 02903, USA.
- Department of Surgery, Rhode Island Hospital, 593 Eddy Street, APC 4, Providence, RI, 02903, USA.
| | - William Law
- The Warren Alpert Medical School, Brown University, 222 Richmond Street, Providence, RI, 02903, USA
- Department of Surgery, Rhode Island Hospital, 593 Eddy Street, APC 4, Providence, RI, 02903, USA
| | - Hannah L Montoya
- The Warren Alpert Medical School, Brown University, 222 Richmond Street, Providence, RI, 02903, USA
- Department of Surgery, Rhode Island Hospital, 593 Eddy Street, APC 4, Providence, RI, 02903, USA
| | - Carla M Moreira
- The Warren Alpert Medical School, Brown University, 222 Richmond Street, Providence, RI, 02903, USA
- Department of Surgery, Rhode Island Hospital, 593 Eddy Street, APC 4, Providence, RI, 02903, USA
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Cordasco KM, Gable AR, Tan GJ, Yuan AH, Yip K, Khafaf M, Hays RD, Faiz JP, Chawla N, Ganz DA. Veteran knowledge, perceptions, and receipt of care following visits to VA emergency departments for ambulatory care sensitive conditions. Acad Emerg Med 2022; 30:252-261. [PMID: 36578158 DOI: 10.1111/acem.14649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 12/22/2022] [Accepted: 12/22/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Receipt of follow-up care after emergency department (ED) visits for chronic ambulatory care sensitive conditions (ACSCs)-asthma, chronic obstructive pulmonary disease, heart failure, diabetes, and/or hypertension-is crucial. We assessed Veterans' follow-up care knowledge, perceptions, and receipt of care after visits to Veterans Health Administration (VA) EDs for chronic ACSCs. METHODS Using explanatory sequential mixed methods, we interviewed Veterans with follow-up care needs after ACSC-related ED visits, and manually reviewed ED notes, abstracting interviewees' documented follow-up needs and care received. RESULTS We interviewed and reviewed ED notes of 35 Veterans, 12-27 (mean 19) days after ED visits. Follow-up care was completely received/scheduled in 20, partially received/scheduled in eight, and not received in seven Veterans. Among those who received care, it was received within specified time frames half the time. However, interviewees often did not recall these time frames or reported them to be longer than specified in the ED notes. Veterans who had not yet received or scheduled follow-up care commonly did not recall follow-up care instructions, believed that they did not need this care since they were not currently having symptoms, or thought that such care would be difficult to obtain due to appointment unavailability and/or difficulties communicating with follow-up care providers. Among the 28 Veterans in whom all or some follow-up care had been received/scheduled, for 25 cases VA staff reached out to the Veteran or the appointment was scheduled prior to or during the ED visit. CONCLUSIONS VA should prioritize implementing processes for EDs to efficiently communicate Veterans' needs to follow-up care providers and systems for reaching out to Veterans and/or arranging for care prior to Veterans leaving the ED. VA should also enhance practices using multimodal approaches for educating Veterans about recommended ED follow-up care and improve mechanisms for Veterans to communicate with follow-up care providers.
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Affiliation(s)
- Kristina M Cordasco
- Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.,Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.,Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California, USA
| | - Alicia R Gable
- Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Gracielle J Tan
- Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Anita H Yuan
- Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Kathleen Yip
- Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.,Department of Emergency Medicine, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California, USA
| | - Mana Khafaf
- Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.,Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California, USA
| | - Ron D Hays
- Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California, USA.,RAND Corporation, Santa Monica, California, USA
| | - Jessica P Faiz
- Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.,National Clinician Scholars Program, University of California, Los Angeles, Los Angeles, California, USA
| | - Neetu Chawla
- Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - David A Ganz
- Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.,Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.,Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California, USA.,RAND Corporation, Santa Monica, California, USA
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Abuaish M, Mirza G, Al-Zamzami W, Atiyah M. The Effect of a Structured Gastroenteritis Discharge Management Plan on Compliance, Prognosis, and Parents' Satisfaction. Cureus 2022; 14:e23240. [PMID: 35449640 PMCID: PMC9012551 DOI: 10.7759/cureus.23240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2022] [Indexed: 12/05/2022] Open
Abstract
Background: Acute gastroenteritis is one of the most common causes of dehydration in children. Parents’ education is an essential part of its management. In this study, we assessed the efficacy of discharge instructions in the pediatric emergency department for parents of children with acute gastroenteritis, together with disease prognosis and parents’ satisfaction. Methods: An observational prospective cohort study was conducted among parents of children with acute gastroenteritis, with mild-to-moderate dehydration, who presented to the pediatric emergency room from March 2018 to July 2018. Parents were interviewed upon their child’s presentation and in follow-up phone calls after one week to assess the parents’ knowledge and the disease’s prognosis. Results: There were a total of 218 parents of children with acute gastroenteritis of mild and moderate dehydration. The mean age was four years and one month ± three years and seven months. Forty-four percent of study participants had reasonable awareness of their child’s condition, and most patients (86%) improved fully. The exact adherence to instructions was 54%, the proportion of children who returned to the emergency department was 13%, and parental satisfaction and appreciation of the provided education was 98%. Conclusion: In the study group, not strictly following fluid rehydration plans in discharge instructions did not negatively affect the course of improvement. This indicates that simple instructions to rehydrate with any fluid a child might accept and give clear red flags for observation are likely to be enough to treat gastroenteritis of mild-to-moderate severity.
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Stephen JM, Zoucha R. Spanish Speaking, Limited English Proficient Parents whose Children are Hospitalized: An Integrative Review. J Pediatr Nurs 2020; 52:30-40. [PMID: 32163844 DOI: 10.1016/j.pedn.2020.02.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 02/16/2020] [Accepted: 02/18/2020] [Indexed: 12/14/2022]
Abstract
PROBLEM Children of non-English speakers are at risk for health disparities. Little is known about the experiences of Spanish speaking parents with limited English proficiency (LEP) whose children are hospitalized. The purposes of this integrative review were to explore what is known and to identify gaps in the literature about the experiences of Spanish speaking parents with LEP whose children are hospitalized. ELIGIBILITY CRITERIA Whittemore and Knafl's (2005) integrative review method guided the process. Studies addressed Spanish speaking parents of hospitalized children in the United States. SAMPLE A final sample consisted of 36 quantitative and qualitative research studies published from 1994 to 2018; located through a search of CINAHL, Pubmed, and Scopus. RESULTS Language services were inconsistent although mandated by standards and laws. Parents experienced mixed emotions related to care. Emergency departments in large, urban cities were the most common care settings. Differences in care outcomes and safety risks for children of Spanish speaking parents existed; however, findings were inconsistent. Only three of the 36 studies addressed nursing care. CONCLUSIONS Research design and quality varied. Parents valued communication in their language. Nurses are the primary healthcare provider in the hospital setting but few studies explored parents' experiences associated with nursing care. No studies explored parents' experiences with their child's hospitalization in the context of culture. IMPLICATIONS Future research is needed to explore the cultural values, beliefs, and experiences of Spanish speaking parents with LEP and the role of nurses and to inform culturally congruent nursing care, research, and policy.
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Hoek AE, Anker SC, van Beeck EF, Burdorf A, Rood PP, Haagsma JA. Patient Discharge Instructions in the Emergency Department and Their Effects on Comprehension and Recall of Discharge Instructions: A Systematic Review and Meta-analysis. Ann Emerg Med 2020; 75:435-444. [DOI: 10.1016/j.annemergmed.2019.06.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 05/10/2019] [Accepted: 06/10/2019] [Indexed: 10/26/2022]
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Glick AF, Farkas JS, Rosenberg RE, Mendelsohn AL, Tomopoulos S, Fierman AH, Dreyer BP, Migotsky M, Melgar J, Yin HS. Accuracy of Parent Perception of Comprehension of Discharge Instructions: Role of Plan Complexity and Health Literacy. Acad Pediatr 2020; 20:516-523. [PMID: 31954854 PMCID: PMC7200278 DOI: 10.1016/j.acap.2020.01.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 01/03/2020] [Accepted: 01/08/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Inpatient discharge education is often suboptimal. Measures of parents' perceived comprehension of discharge instructions are included in national metrics given linkage to morbidity; few studies compare parents' perceived and actual comprehension. We 1) compared parent perceived and actual comprehension of discharge instructions and 2) assessed associations between plan complexity and parent health literacy with overestimation of comprehension (perceive comprehension but lack actual comprehension). METHODS Prospective cohort study of English/Spanish-speaking parents (n = 192) of inpatients ≤12 years old and discharged on ≥1 daily medication from an urban public hospital. We used McNemar's tests to compare parent perceived (agree/strongly agree on 5-point Likert scale) and actual comprehension (concordance of parent report with medical record) of instructions (domains: medications, appointments, return precautions, and restrictions). Generalized estimating equations were performed to assess associations between low parent health literacy (Newest Vital Sign score ≤3) and plan complexity with overestimation of comprehension. RESULTS Medication side effects were the domain with lowest perceived comprehension (80%), while >95% of parents perceived comprehension for other domains. Actual comprehension varied by domain (41%-87%) and was lower than perceived comprehension. Most (84%) parents overestimated comprehension in ≥1 domain. Plan complexity (adjusted odds ratio 3.6; 95% confidence interval 2.9-4.7) and low health literacy (adjusted odds ratio 1.9; 1.3-2.6) were associated with overestimation of comprehension. CONCLUSIONS Parental perceived comprehension of discharge instructions overestimated actual comprehension in most domains. Plan complexity and low health literacy were associated with overestimation of comprehension. Future interventions should incorporate assessment of actual comprehension and standardization of discharge instructions.
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Affiliation(s)
- Alexander F. Glick
- New York University School of Medicine/NYU Langone Health/Bellevue Hospital Center, Department of Pediatrics, 462 1st Avenue, New York, NY, USA,Corresponding Author: Alexander F. Glick, MD, MS, NYU School of Medicine/Bellevue Hospital Center, Department of Pediatrics, 462 First Avenue, New York, NY 10016, Phone: 212-263-8198, Fax: 212-562-6019,
| | - Jonathan S. Farkas
- New York University School of Medicine/NYU Langone Health/Bellevue Hospital Center, Department of Pediatrics, 462 1st Avenue, New York, NY, USA
| | - Rebecca E. Rosenberg
- New York University School of Medicine/NYU Langone Health/Bellevue Hospital Center, Department of Pediatrics, 462 1st Avenue, New York, NY, USA
| | - Alan L. Mendelsohn
- New York University School of Medicine/NYU Langone Health/Bellevue Hospital Center, Department of Pediatrics, 462 1st Avenue, New York, NY, USA
| | - Suzy Tomopoulos
- New York University School of Medicine/NYU Langone Health/Bellevue Hospital Center, Department of Pediatrics, 462 1st Avenue, New York, NY, USA
| | - Arthur H. Fierman
- New York University School of Medicine/NYU Langone Health/Bellevue Hospital Center, Department of Pediatrics, 462 1st Avenue, New York, NY, USA
| | - Benard P. Dreyer
- New York University School of Medicine/NYU Langone Health/Bellevue Hospital Center, Department of Pediatrics, 462 1st Avenue, New York, NY, USA
| | - Michael Migotsky
- New York University School of Medicine/NYU Langone Health/Bellevue Hospital Center, Department of Pediatrics, 462 1st Avenue, New York, NY, USA
| | - Jennifer Melgar
- New York University School of Medicine/NYU Langone Health/Bellevue Hospital Center, Department of Pediatrics, 462 1st Avenue, New York, NY, USA
| | - H. Shonna Yin
- New York University School of Medicine/NYU Langone Health/Bellevue Hospital Center, Department of Pediatrics, 462 1st Avenue, New York, NY, USA
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Abstract
Health literacy is an important issue to consider in the provision of health-care to children. Similar to the adult population, most parents face health literacy challenges. Of particular concern, 1 in 4 parents have low health literacy, greatly affecting their ability to use health information to make health decisions for their child. High expectations are placed on parents and children to achieve effective disease management and positive health outcomes in the context of complex health-care systems and disease treatment regimens. Low health literacy affects parent acquisition of knowledge, attitudes, and behaviors, as well as child health outcomes across the domains of disease prevention, acute illness care, and chronic illness care. The effect of low health literacy is wide ranging, including 1) poor nutrition knowledge and behaviors, 2) higher obesity rates, 3) more medication errors, 4) more emergency department use, and 5) poor asthma knowledge, behaviors, and outcomes. Health-care providers can mitigate the effects of health literacy by seeking to align health-care demands with the health literacy skills of families. Effective health literacy-informed interventions provide insights into methods that can be used by providers and health systems to improve health outcomes. Health literacy-informed communication strategies should be used with all families in a "universal precautions approach" because all parents likely benefit from clear communication. As scientific advances are made in disease prevention and management, unless families understand how to follow provider recommendations, the benefit of these advances will not be realized and disparities in outcomes will be exacerbated.
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Affiliation(s)
- Andrea K Morrison
- Section of Emergency Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | | | - H Shonna Yin
- Department of Pediatrics and.,Department of Population Health, New York University School of Medicine/NYU Langone Health, New York, NY
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Curran JA, Gallant AJ, Zemek R, Newton AS, Jabbour M, Chorney J, Murphy A, Hartling L, MacWilliams K, Plint A, MacPhee S, Bishop A, Campbell SG. Discharge communication practices in pediatric emergency care: a systematic review and narrative synthesis. Syst Rev 2019; 8:83. [PMID: 30944038 PMCID: PMC6446263 DOI: 10.1186/s13643-019-0995-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 03/22/2019] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The majority of children receiving care in the emergency department (ED) are discharged home, making discharge communication a key component of quality emergency care. Parents must have the knowledge and skills to effectively manage their child's ongoing care at home. Parental fatigue and stress, health literacy, and the fragmented nature of communication in the ED setting may contribute to suboptimal parent comprehension of discharge instructions and inappropriate ED return visits. The aim of this study was to examine how and why discharge communication works in a pediatric ED context and develop recommendations for practice, policy, and research. METHODS We systematically reviewed the published and gray literature. We searched electronic databases CINAHL, Medline, and Embase up to July 2017. Policies guiding discharge communication were also sought from pediatric emergency networks in Canada, USA, Australia, and the UK. Eligible studies included children less than 19 years of age with a focus on discharge communication in the ED as the primary objective. Included studies were appraised using relevant Joanna Briggs Institute (JBI) checklists. Textual summaries, content analysis, and conceptual mapping assisted with exploring relationships within and between data. We implemented an integrated knowledge translation approach to strengthen the relevancy of our research questions and assist with summarizing our findings. RESULTS A total of 5095 studies were identified in the initial search, with 75 articles included in the final review. Included studies focused on a range of illness presentations and employed a variety of strategies to deliver discharge instructions. Education was the most common intervention and the majority of studies targeted parent knowledge or behavior. Few interventions attempted to change healthcare provider knowledge or behavior. Assessing barriers to implementation, identifying relevant ED contextual factors, and understanding provider and patient attitudes and beliefs about discharge communication were identified as important factors for improving discharge communication practice. CONCLUSION Existing literature examining discharge communication in pediatric emergency care varies widely. A theory-based approach to intervention design is needed to improve our understanding regarding discharge communication practice. Strengthening discharge communication in a pediatric emergency context presents a significant opportunity for improving parent comprehension and health outcomes for children. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration number: CRD42014007106.
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Affiliation(s)
- Janet A. Curran
- School of Nursing, Dalhousie University, 5869 University Ave., PO Box 15000, Halifax, NS B3H 4R2 Canada
| | - Allyson J. Gallant
- School of Nursing, Dalhousie University, 5869 University Ave., PO Box 15000, Halifax, NS B3H 4R2 Canada
| | - Roger Zemek
- Department of Pediatrics, Division of Emergency Medicine, Children’s Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, ON K1H 8L1 Canada
| | - Amanda S. Newton
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, 11405-87 Avenue, Edmonton, AB T6G 1C9 Canada
| | - Mona Jabbour
- Department of Pediatrics, Division of Emergency Medicine, Children’s Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, ON K1H 8L1 Canada
| | - Jill Chorney
- IWK Health Center, 5850/5980 University Avenue, PO Box 9700, Halifax, NS B3K 6R8 Canada
| | - Andrea Murphy
- College of Pharmacy, Dalhousie University, 5869 University Avenue, PO Box 15000, Halifax, NS B3H 4R2 Canada
| | - Lisa Hartling
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, 11405-87 Avenue, Edmonton, AB T6G 1C9 Canada
| | - Kate MacWilliams
- School of Nursing, Dalhousie University, 5869 University Ave., PO Box 15000, Halifax, NS B3H 4R2 Canada
| | - Amy Plint
- Department of Pediatrics, Division of Emergency Medicine, Children’s Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, ON K1H 8L1 Canada
| | - Shannon MacPhee
- IWK Health Center, 5850/5980 University Avenue, PO Box 9700, Halifax, NS B3K 6R8 Canada
| | - Andrea Bishop
- School of Nursing, Dalhousie University, 5869 University Ave., PO Box 15000, Halifax, NS B3H 4R2 Canada
| | - Samuel G. Campbell
- Charles V. Keating Emergency and Trauma Centre, QEII Health Sciences Centre, 1796 Summer St, Halifax, NS B3H 3A7 Canada
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Benjamin LS, Carney MM. Furthering the Value of the Emergency Department Beyond Its Walls: Transitions to the Medical Home for Pediatric Emergency Patients. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2018. [DOI: 10.1016/j.cpem.2018.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Navanandan N, Schmidt SK, Cabrera N, DiStefano MC, Mistry RD. The Caregiver Perspective on Unscheduled 72-Hour Return Visits to Pediatric Acute Care Sites: A Focus on Discharge Processes. Acad Pediatr 2017; 17:755-761. [PMID: 28215655 DOI: 10.1016/j.acap.2017.02.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Revised: 02/01/2017] [Accepted: 02/05/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To characterize pediatric caregivers' reasons for 72-hour emergency department (ED) and urgent care (UC) returns. METHODS A sample of caregivers returning within 72 hours of initial visit to a pediatric ED or affiliated UC site was surveyed from November 2014 to June 2015; patients evaluated at outside ED/UC, scheduled for return, or non-English/Spanish speaking were excluded. Caregiver surveys underwent item generation, validation, and pilot testing. Survey items included caregiver reasons for unscheduled returns, with a specific assessment of delivery of key components of discharge instructions (diagnosis, duration of illness, home care, return precautions). Complete delivery of instructions was defined by caregiver reported receipt of instructions on all 4 components. RESULTS Of the 500 caregiver surveys analyzed 495 children received a 72-hour return ED/UC visit. Mean age of caregivers was 33 years, 62% completed college. Children were 2 years of age or younger (47%), male (52%), Caucasian (55%), and publicly insured (64%). Reported reasons for ED/UC return included belief that their child's illness had not resolved (51%) or worsened (41%). Many caregivers (41%) were not instructed on all key components of discharge. Almost half of caregivers (47%) were not educated on anticipated duration of illness. Complete delivery of discharge instructions was associated with ED/UC satisfaction (odds ratio, 5.7; 95% confidence interval, 3.8-8.5). CONCLUSIONS Among caregivers of children returning for an unscheduled ED/UC visit, most do not receive complete discharge instructions at initial visit. Improving delivery of key components of discharge instructions has the potential to increase ED/UC satisfaction and reduce unscheduled 72-hour returns.
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Affiliation(s)
- Nidhya Navanandan
- Section of Pediatric Emergency Medicine, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora.
| | - Sarah K Schmidt
- Section of Pediatric Emergency Medicine, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora
| | - Natasha Cabrera
- Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora
| | - Michael C DiStefano
- Section of Pediatric Emergency Medicine, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora
| | - Rakesh D Mistry
- Section of Pediatric Emergency Medicine, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora
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Glick AF, Farkas JS, Nicholson J, Dreyer BP, Fears M, Bandera C, Stolper T, Gerber N, Yin HS. Parental Management of Discharge Instructions: A Systematic Review. Pediatrics 2017; 140:e20164165. [PMID: 28739657 PMCID: PMC5527669 DOI: 10.1542/peds.2016-4165] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/17/2017] [Indexed: 12/24/2022] Open
Abstract
CONTEXT Parents often manage complex instructions when their children are discharged from the inpatient setting or emergency department (ED); misunderstanding instructions can put children at risk for adverse outcomes. Parents' ability to manage discharge instructions has not been examined before in a systematic review. OBJECTIVE To perform a systematic review of the literature related to parental management (knowledge and execution) of inpatient and ED discharge instructions. DATA SOURCES We consulted PubMed/Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, and Cochrane CENTRAL (from database inception to January 1, 2017). STUDY SELECTION We selected experimental or observational studies in the inpatient or ED settings in which parental knowledge or execution of discharge instructions were evaluated. DATA EXTRACTION Two authors independently screened potential studies for inclusion and extracted data from eligible articles by using a structured form. RESULTS Sixty-four studies met inclusion criteria; most (n = 48) were ED studies. Medication dosing and adherence errors were common; knowledge of medication side effects was understudied (n = 1). Parents frequently missed follow-up appointments and misunderstood return precaution instructions. Few researchers conducted studies that assessed management of instructions related to diagnosis (n = 3), restrictions (n = 2), or equipment (n = 1). Complex discharge plans (eg, multiple medicines or appointments), limited English proficiency, and public or no insurance were associated with errors. Few researchers conducted studies that evaluated the role of parent health literacy (ED, n = 5; inpatient, n = 0). LIMITATIONS The studies were primarily observational in nature. CONCLUSIONS Parents frequently make errors related to knowledge and execution of inpatient and ED discharge instructions. Researchers in the future should assess parental management of instructions for domains that are less well studied and focus on the design of interventions to improve discharge plan management.
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Affiliation(s)
- Alexander F Glick
- New York University School of Medicine, New York, New York; and
- Bellevue Hospital Center, New York, New York
| | - Jonathan S Farkas
- New York University School of Medicine, New York, New York; and
- Bellevue Hospital Center, New York, New York
| | | | - Benard P Dreyer
- New York University School of Medicine, New York, New York; and
- Bellevue Hospital Center, New York, New York
| | - Melissa Fears
- New York University School of Medicine, New York, New York; and
- Bellevue Hospital Center, New York, New York
| | - Christopher Bandera
- New York University School of Medicine, New York, New York; and
- Bellevue Hospital Center, New York, New York
| | - Tanya Stolper
- New York University School of Medicine, New York, New York; and
- Bellevue Hospital Center, New York, New York
| | - Nicole Gerber
- New York University School of Medicine, New York, New York; and
- Bellevue Hospital Center, New York, New York
| | - H Shonna Yin
- New York University School of Medicine, New York, New York; and
- Bellevue Hospital Center, New York, New York
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12
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Thomas DG, Bradley L, Servi A, Reilly S, Niskala Apps J, McCrea M, Hammeke T. Parental Knowledge and Recall of Concussion Discharge Instructions. J Emerg Nurs 2017; 44:52-56. [PMID: 28527643 DOI: 10.1016/j.jen.2017.04.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 03/31/2017] [Accepted: 04/12/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Children increasingly are being seen in the emergency department for a concussion, or mild traumatic brain injury (mTBI). A key aim of the ED visit is to provide discharge advice that can help parents to identify an evolving neurosurgical crisis, facilitate recovery, and prevent reinjury. The present study examined parents' knowledge of symptoms and recall of discharge instructions after their adolescent's mTBI and the effect of supplementing written discharge instructions with verbal instruction and reinforcement. METHODS We performed a nested observational study of parents/caregivers of patients who participated in a larger mTBI study. After their adolescent's mTBI, parents were given verbal and standardized written instructions. The ED discharge process was observed using a structured checklist, and parents were surveyed 3 days after discharge on knowledge and recall of discharge instructions. RESULTS Ninety-three parents completed the postsurvey. Nearly 1 in 5 parents were confused about when to return to the emergency department after evaluation for head injury. Up to 1 in 4 parents could not recall specific discharge advice related to concussion. Parents who received verbal reinforcement of written discharge instructions were more likely to recall them. CONCLUSION Emergency nurses and clinicians should strive to utilize both verbal and written discharge instructions with families to help increase understanding.
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Bahm A, Freedman SB, Guan J, Guttmann A. Evaluating the Impact of Clinical Decision Tools in Pediatric Acute Gastroenteritis: A Population-based Cohort Study. Acad Emerg Med 2016; 23:599-609. [PMID: 26824763 DOI: 10.1111/acem.12915] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 10/06/2015] [Accepted: 11/05/2015] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Acute gastroenteritis (AGE) is a leading cause of pediatric emergency department (ED) visits. Despite evidence-based guidelines, variation in adherence exists. Clinical decision tools can enhance evidence-based care, but little is known about their use and effectiveness in pediatric AGE. This study sought to determine if the following tools-1) pathways/order sets, 2) medical directives for oral rehydration therapy (ORT) or ondansetron, and 3) printed discharge instructions-are associated with AGE admission and ED revisits. METHODS This was a retrospective population-based cohort study of all children 3 months-18 years with an AGE ED visit in Ontario, Canada, from 2008 to 2010, using linked survey and health administrative databases. Logistic regression models associating clinical decision tools (CDTs) with hospitalizations and revisits controlling for hospital and patient characteristics were employed. RESULTS Of the 57,921 patient visits during the study period, there were 2,401 hospitalizations (4.2%). A total of 55,520 patients were discharged from the ED, with 2,378 (4.3%) experiencing a 72-hour return visit. In adjusted models, none of the tools were significantly associated with admission. Medical directive for ORT was associated with lower return visit rates (adjusted odds ratio [aOR] = 0.86, 95% confidence interval [CI] = 0.79-0.94] and printed discharge instructions with higher return visits (aOR = 1.33, 95% CI = 1.08-1.65); pathways/order sets and medical directives for ondansetron had no association. CONCLUSIONS Admissions in children with AGE are not associated with the presence of CDTs. While ORT medical directives are associated with lower ED revisits, printed discharge instructions have the opposite effect. The simple presence/absence of decision support tools does not guarantee improved clinical outcomes.
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Affiliation(s)
- Allison Bahm
- Hospital for Sick Children and the Department of Paediatrics; University of Toronto; Toronto Ontario Canada
| | - Stephen B. Freedman
- Sections of Pediatric Emergency Medicine and Gastroenterology; Alberta Children's Hospital; Alberta Children's Hospital Research Institute; University of Calgary; Calgary Alberta Canada
| | - Jun Guan
- Institute for Clinical Evaluative Sciences; Toronto Ontario Canada
| | - Astrid Guttmann
- Hospital for Sick Children and the Department of Paediatrics; University of Toronto; Toronto Ontario Canada
- Institute for Clinical Evaluative Sciences; Toronto Ontario Canada
- Department of Health Policy, Management and Evaluation; University of Toronto; Toronto Ontario Canada
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de Vos-Kerkhof E, Geurts DHF, Wiggers M, Moll HA, Oostenbrink R. Tools for 'safety netting' in common paediatric illnesses: a systematic review in emergency care. Arch Dis Child 2016; 101:131-9. [PMID: 26163122 DOI: 10.1136/archdischild-2014-306953] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 06/17/2015] [Indexed: 11/04/2022]
Abstract
CONTEXT Follow-up strategies after emergency department (ED) discharge, alias safety netting, is often based on the gut feeling of the attending physician. OBJECTIVE To systematically identify evaluated safety-netting strategies after ED discharge and to describe determinants of paediatric ED revisits. DATA SOURCES MEDLINE, Embase, CINAHL, Cochrane central, OvidSP, Web of Science, Google Scholar, PubMed. STUDY SELECTION Studies of any design reporting on safety netting/follow-up after ED discharge and/or determinants of ED revisits for the total paediatric population or specifically for children with fever, dyspnoea and/or gastroenteritis. Outcomes included complicated course of disease after initial ED visit (eg, revisits, hospitalisation). DATA EXTRACTION Two reviewers independently assessed studies for eligibility and study quality. As meta-analysis was not possible due to heterogeneity of studies, we performed a narrative synthesis of study results. A best-evidence synthesis was used to identify the level of evidence. RESULTS We summarised 58 studies, 36% (21/58) were assessed as having low risk of bias. Limited evidence was observed for different strategies of safety netting, with educational interventions being mostly studied. Young children, a relevant medical history, infectious/respiratory symptoms or seizures and progression/persistence of symptoms were strongly associated with ED revisits. Gender, emergency crowding, physicians' characteristics and diagnostic tests and/or therapeutic interventions at the index visit were not associated with revisits. CONCLUSIONS Within the heterogeneous available evidence, we identified a set of strong determinants of revisits that identify high-risk groups in need for safety netting in paediatric emergency care being related to age and clinical symptoms. Gaps remain on intervention studies concerning specific application of a uniform safety-netting strategy and its included time frame.
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Affiliation(s)
- Evelien de Vos-Kerkhof
- Department of General Paediatrics, ErasmusMC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Dorien H F Geurts
- Department of General Paediatrics, ErasmusMC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | | | - Henriette A Moll
- Department of General Paediatrics, ErasmusMC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Rianne Oostenbrink
- Department of General Paediatrics, ErasmusMC-Sophia Children's Hospital, Rotterdam, The Netherlands
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Desai AD, Popalisky J, Simon TD, Mangione-Smith RM. The effectiveness of family-centered transition processes from hospital settings to home: a review of the literature. Hosp Pediatr 2015; 5:219-31. [PMID: 25832977 DOI: 10.1542/hpeds.2014-0097] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVES The quality of care transitions is of growing concern because of a high incidence of postdischarge adverse events, poor communication with patients, and inadequate information transfer between providers. The objective of this study was to conduct a targeted literature review of studies examining the effectiveness of family-centered transition processes from hospital- and emergency department (ED)-to-home for improving patient health outcomes and health care utilization. METHODS We conducted an electronic search (2001-2012) of PubMed, CINAHL, Cochrane, PsycInfo, Embase, and Web of Science databases. Included were experimental studies of hospital and ED-to-home transition interventions in pediatric and adult populations meeting the following inclusion criteria: studies evaluating hospital or ED-to-home transition interventions, study interventions involving patients/families, studies measuring outcomes≤30 days after discharge, and US studies. Transition processes, principal outcome measures (patient health outcomes and health care utilization), and assessment time-frames were extracted for each study. RESULTS The search yielded 3458 articles, and 16 clinical trials met final inclusion criteria. Four studies evaluated pediatric ED-to-home transitions and indicated family-tailored discharge education was associated with better patient health outcomes. Remaining trials evaluating adult hospital-to-home transitions indicated a transition needs assessment or provision of an individualized transition record was associated with better patient health outcomes and reductions in health care utilization. The effectiveness of postdischarge telephone follow-up and/or home visits on health care utilization showed mixed results. CONCLUSIONS Patient-tailored discharge education is associated with improved patient health outcomes in pediatric ED patients. Effective transition processes identified in the adult literature may inform future quality improvement research regarding pediatric hospital-to-home transitions.
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Affiliation(s)
- Arti D Desai
- Department of Pediatrics, University of Washington, Seattle, Washington; and Seattle Children's Research Institute, Seattle, Washington
| | - Jean Popalisky
- Seattle Children's Research Institute, Seattle, Washington
| | - Tamara D Simon
- Department of Pediatrics, University of Washington, Seattle, Washington; and Seattle Children's Research Institute, Seattle, Washington
| | - Rita M Mangione-Smith
- Department of Pediatrics, University of Washington, Seattle, Washington; and Seattle Children's Research Institute, Seattle, Washington
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Riera A, Navas-Nazario A, Shabanova V, Vaca FE. The impact of limited English proficiency on asthma action plan use. J Asthma 2013; 51:178-84. [PMID: 24147607 DOI: 10.3109/02770903.2013.858266] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The goal of this study was to compare rates of asthma action plan use by limited English proficiency (LEP) caregivers to English proficient (EP) caregivers. METHODS A cross-sectional bilingual survey was distributed at an urban, academic, pediatric emergency department (PED). Surveys were completed by adult caregivers of children with asthma who sought PED care for asthma related chief complaints. LEP was defined as caregiver ability to speak English less than "very well". Data were analyzed using Fisher's exact test and odds ratios (OR). RESULTS One hundred seven surveys were completed and analyzed. Fifty-one surveys (48%) were completed by LEP caregivers and 56 (52%) by EP caregivers. A 25% difference (p = .01) in action plan use rates between LEP caregivers (39%) and EP caregivers (64%) was observed. EP alone was associated with action plan use (OR 2.8 [95% CI 1.3-6.1]). Variables not associated with plan use included mother acting as caregiver (OR 2.1 [95% CI 0.7-7.0]), age of child >7 years (OR 1.0 [95% CI 0.5-2.4]), caregiver education ≥ associate degree (OR 1.4 [95% CI 0.6-3.0]), private insurance (OR 0.7 [95% CI 0.3-1.8]), White race (OR 0.7 [95% CI 0.2-2.2]), Latino ethnicity (OR 0.5 [95% CI 0.2-1.3]) and a federally qualified health center (OR 0.8 [95% CI 0.3-2.0]). The main caregiver reasons for plan use were feeling that a plan works/gets results, helps with symptom management and appreciation towards physician attentiveness when a plan is prescribed. The main caregiver reasons for non plan use were they were not informed/given an action plan or perceived the child's asthma as mild/well controlled. CONCLUSION Compared with EP caregivers, those with LEP experience disparate rates of asthma action plan use.
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Affiliation(s)
- Antonio Riera
- Depatment of Pediatric Emergency Medicine, Yale University , New Haven, CT , USA
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Using video discharge instructions as an adjunct to standard written instructions improved caregivers' understanding of their child's emergency department visit, plan, and follow-up: a randomized controlled trial. Pediatr Emerg Care 2013; 29:699-704. [PMID: 23714763 DOI: 10.1097/pec.0b013e3182955480] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Previous studies demonstrate that patients often have difficulty understanding their discharge instructions. Video discharge instructions have the potential to mitigate factors such as illiteracy and limited physician time, which may affect comprehension. Our goal is to determine if adding video discharge instructions affects caregivers' understanding of their child's emergency department (ED) visit, plan, and follow-up. METHODS Caregivers of patients, aged 29 days to 18 years, with a diagnosis of fever, vomiting or diarrhea, and wheezing or asthma were randomized into written or video discharge instruction groups. In the ED, caregivers read standard written discharge instructions or watched a 3-minute video based on their child's diagnosis. They were then asked questions regarding information covered in these instructions. After completing the 20-point questionnaire, standard discharge procedure was followed. Caregivers were contacted by phone 2 to 5 days after discharge for a follow-up questionnaire. Usefulness of the discharge instructions was also assessed. RESULTS Of 436 caregivers enrolled, 220 received written and 216 received video discharge instructions. The follow-up questionnaire was completed by 341 caregivers. The group receiving video discharge instructions scored significantly higher in the ED (12.2 vs 8.9) and 2 to 5 days after discharge (11.1 vs 7.8). At follow-up, 29% of the written and 42% of the video groups rated their discharge instructions as being extremely helpful. CONCLUSIONS Brief video discharge instructions improved caregiver knowledge both in the ED and 2 to 5 days after discharge compared with written discharge instructions alone. Caregiver satisfaction with video discharge instructions was also greater than with written discharge instructions.
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Alberti TL, Nannini A. Patient comprehension of discharge instructions from the emergency department: A literature review. ACTA ACUST UNITED AC 2012; 25:186-194. [DOI: 10.1111/j.1745-7599.2012.00767.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | - Angela Nannini
- University of Massachusetts Lowell, Lowell; Massachusetts
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Internet access and electronic communication among families in an urban pediatric emergency department. Pediatr Emerg Care 2012; 28:553-7. [PMID: 22653452 DOI: 10.1097/pec.0b013e318258ad76] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The Internet may represent an opportunity for health care providers in the emergency department (ED) to deliver discharge instructions and after-care educational materials electronically to patients and their caregivers. OBJECTIVES The objectives of this study were to determine the prevalence of Internet access and use among caregivers of children who visit the ED and to evaluate their interest in receiving after-care communication and educational material electronically. METHODS We distributed a self-administered survey to a convenience sample of English-speaking caregivers of children who presented to the ED of an urban, academic, pediatric hospital during November and December 2009. RESULTS The survey was distributed to and completed by 509 English-speaking respondents. Of the participants, 423 (83.1%) of 509 identified themselves as black/African American, and 397 (77.9%) of 509 were publicly insured. Of the participants, 503 of 509 (98.9%; 95% confidence interval [CI], 97.9%-99.8%) reported that they have access to the Internet. Of the participants with Internet access, 312 of 503 (62.0%; 95% CI, 57.8%-66.3%) have access at home, 166 of 503 (33.0%; 95% CI, 28.9%-33.1%) have access at work, and 112 of 503 (22.3%; 95% CI, 18.6%-25.9%) have access by mobile phone. When asked about electronic communication and social networking, 483 of 503 (96.0%; 95% CI, 94.3%-97.7%) have an e-mail account, and 304 of 503 (60.4%; 95% CI, 56.2%-64.7%) have a Facebook account. Furthermore, 353 of 503 (70.1%; 95% CI, 66.2%-74.2%) reported accessing the Internet daily, whereas 128 of 503 (25.4%; 95% CI, 21.6%-29.3%) access the Internet at least 2 to 6 times per week. Among all respondents, interest in receiving communication from the ED only electronically was expressed by 259 of 509 participants (50.9%; 95% CI, 46.5%-55.2%). Approximately one third of the participants (173/509 [34%; 95% CI, 29.9%-38.1%]) expressed interest in an electronic channel for communication between the ED and their child's patient primary care provider. CONCLUSIONS In this predominantly minority and economically disadvantaged population of caregivers presenting to an urban pediatric ED, a large majority reported regular access to the Internet and willingness and ability to receive communication from the ED via electronic means.
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Samuels-Kalow ME, Stack AM, Porter SC. Effective discharge communication in the emergency department. Ann Emerg Med 2012; 60:152-9. [PMID: 22221840 DOI: 10.1016/j.annemergmed.2011.10.023] [Citation(s) in RCA: 121] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Revised: 10/24/2011] [Accepted: 10/27/2011] [Indexed: 12/27/2022]
Abstract
Communication at discharge is an important part of high-quality emergency department (ED) care. This review describes the existing literature on patient understanding and implementation of discharge instructions, discusses previous interventions aimed at improving the discharge process, and recommends best practices and future research. MEDLINE and Cochrane databases were searched, using combinations of key terms. Literature from both the adult and pediatric ED populations was reviewed. Multiple reports have shown deficient comprehension at discharge, with patients or parents frequently unable to report their diagnosis, management plan, or reasons to return. Interventions to improve discharge communication have been, at best, moderately successful. Patients need structured content, presented verbally, with written and visual cues to enhance recall. Written instructions need to be provided in the patient's language and at an appropriate reading level. Understanding should be confirmed before the patient leaves the ED. Further research is needed to describe the optimal content, channel, and timing for the ED discharge process and the relationship between discharge process and outcomes.
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James TD, Carlsen Smith P, Brice JH. Self-reported Discharge Instruction Adherence Among Different Racial Groups Seen in the Emergency Department. J Natl Med Assoc 2010; 102:931-6. [DOI: 10.1016/s0027-9684(15)30712-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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