Emergency physicians as human billboards for injury prevention: a randomized controlled trial

Abstract

Objectives The objective of this study was to evaluate the impact of a novel injury prevention intervention designed to prompt patients to initiate an injury prevention discussion with the ED physician, thus enabling injury prevention counselling and increasing bicycle helmet use among patients. Methods A repeated measures 2 x 3 randomized controlled trial design was used. Fourteen emergency physicians were observed for two shifts each between June and August 2013. Each pair of shifts was randomized to either an injury prevention shift, during which the emergency physician would wear a customized scrub top, or a control shift. The outcomes of interest were physician time spent discussing injury prevention, current helmet use, and self-reported change in helmet use rates at one year. Logistic regression analyses were used to examine the impact of the intervention. Results The average time spent on injury prevention for all patients was 3.3 seconds. For those patients who actually received counselling, the average time spent was 17.0 seconds. The scrub top intervention did not significantly change helmet use rates at one year. The intervention also had no significant impact on patient decisions to change or reinforcement of helmet use. Conclusions Our study showed that the intervention did not increase physician injury prevention counselling or self-reported bicycle helmet use rates among patients. Given the study limitations, replication and extension of the intervention is warranted.

Changes in parents' perceived injury risk after a medically-attended injury to their child

“…However, no difference has been found in studies comparing injury prevention interventions on parents of injured children versus parents visiting for other reasons (Gielen et al, 2007; Gittelman et al, 2012). Moreover, studies examining interventions in the ED have produced mixed results (Sullivan et al, 2017; Gittelman et al, 2006; Johnston et al, 2002; Cushman et al, 1991). Our study provides a plausible explanation for this puzzling finding: since the increased perception of re-injury risk may not be fully realized until weeks later, ED interventions (which typically happen the day of the injury) may not be timed to take full advantage of the increased perceived risk of re-injury associated with a MAI.…”

Injury prevention in the emergency department: An ongoing challenge Reference to: Emergency Physicians as human billboards for injury prevention: A randomized controlled trial by Emily Sullivan et al.

“…There was a minimal change in length of injury prevention counselling among those who were treated by a scrub-wearing physician versus a non-scrub-wearing physician and no change in helmet-wearing behaviour. 1 This is likely disappointing to the authors and to others who are looking for quick opportunities to provide injury prevention counselling in the ED. The authors humbly note many limitations to their study such as the small sample size and high loss to follow-up.…”