Establishing a written advice sheet to patients consulting for wound to emergency ward improves postemergency care

Abstract

OBJECTIVES: Sutures require follow-up visits for favorable evolution. To improve postemergency wound care, we decided to include a standardized advice sheet for patients based on current recommendations. The objective is to assess its effectiveness on outpatients' compliance after being discharged from the emergency department (ED). METHODS: We performed a prospective, pre–post design trial in an ED of a teaching hospital. We included for two consecutive months all patients aged ≥16 years old and consulting for wounds that needed suturing, and we excluded chronic wounds, burns, and hand wounds since they all need special care. During the 1 st month, all patients received during ED visit usual verbal instructions concerning the postemergency care (Group A). During the 2 nd month, all patients received usual verbal instructions and a standardized written advice sheet that detailed postemergency wound care (Group B). We organized telephone follow-up after the suture removal date and asked about dressing changes, appearance of infection signs, and respect of suture removal date. We compared patients;' characteristics in the two groups and performed a multivariable logistic regression using compliance to discharge instructions as our endpoint. RESULTS: For 2 months, 509 patients consulted for wounds. 119 (23.4%) patients were included in the study and followed. Baseline characteristics of patients did not differ between the two groups. Patients who received the advice sheet (Group B) had a better compliance in postemergency care (91.7% vs. 72.9%; P = 0.01). Moreover, there were significantly less dressing changes in Group B than in Group A (5.3 [2.2] vs. 12.9 [7.7]; P < 0.01) and suture removal date was more in agreement with recommendations in Group B (83.9% vs. 66.7%; P = 0.03). Occurrence of infection was not significantly different between groups (9.7% vs. 13.7%; P = 0.37). CONCLUSION: For the management of wound care, discharge hospital process including a written advice sheet improves outpatients' compliance and postemergency care.

Evaluation of Interventions Targeting Follow-up Appointment Scheduling After Emergency Department Referral to Ophthalmology Clinics Using A3 Problem Solving

“…There are many reported clinician and health system activities that can improve follow-up after ED evaluation . Creation of an appointment prior to ED release, telephone reminders, engagement with specialty clinicians at ED point of care, written instructions, and greater referral accessibility are associated with increased follow-up rates. In addition, multiple studies have shown that reducing or eliminating barriers to care (eg, transportation, childcare, and cost) is associated with increases in the rate of successful follow-up .…”