Improving Discharge Instructions Following a Concussion Diagnosis in the Pediatric Emergency Department: A Pre-post Intervention Study

Yengo‐Kahn, Aaron M.; Hibshman, Natalie; Bezzerides, Michael; Feldman, Michael J.; Vukovic, Adam A.; Mummareddy, Nishit; Zhao, Shilin; Penrod, Cody H.; Bonfield, Christopher M.; Vance, E Haley

doi:10.1097/pq9.0000000000000456

Cited by 4 publications

(1 citation statement)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…No other published randomized trial has tested the impact of implementing a clinical pathway for pediatric concussion in the ED, although a prior quality improvement study showed a simple intervention increased the completeness of discharge instructions [ 29 ]. In our study, the design and implementation of the clinical pathway were guided by an evidence-based, theory-driven approach, but also relied on extensive input from site physicians and nurses.…”

Section: Discussionmentioning

confidence: 99%

Health care impact of implementing a clinical pathway for acute care of pediatric concussion: a stepped wedge, cluster randomised trial

Yeates,

Barlow,

Wright

et al. 2023

Can J Emerg Med

View full text Add to dashboard Cite

Objectives To test the effects of actively implementing a clinical pathway for acute care of pediatric concussion on health care utilization and costs. Methods Stepped wedge, cluster randomized trial of a clinical pathway, conducted in 5 emergency departments (ED) in Alberta, Canada from February 1 to November 30, 2019. The clinical pathway emphasized standardized assessment of risk for persistent symptoms, provision of consistent information to patients and families, and referral for outpatient follow-up. De-identified administrative data measured 6 outcomes: ED return visits; outpatient follow-up visits; length of ED stay, including total time, time from triage to physician initial assessment, and time from physician initial assessment to disposition; and total physician claims in an episode of care. Results A total of 2878 unique patients (1164 female, 1713 male) aged 5–17 years (median 11.00, IQR 8, 14) met case criteria. They completed 3009 visits to the 5 sites and 781 follow-up visits to outpatient care, constituting 2910 episodes of care. Implementation did not alter the likelihood of an ED return visit (OR 0.77, 95% CI 0.39, 1.52), but increased the likelihood of outpatient follow-up visits (OR 1.84, 95% CI 1.19, 2.85). Total length of ED stay was unchanged, but time from physician initial assessment to disposition decreased significantly (mean change − 23.76 min, 95% CI − 37.99, − 9.52). Total physician claims increased significantly at only 1 of 5 sites. Conclusions Implementation of a clinical pathway in the ED increased outpatient follow-up and reduced the time from physician initial assessment to disposition, without increasing physician costs. Implementation of a clinical pathway can align acute care of pediatric concussion more closely with existing clinical practice guidelines while making care more efficient. Trial registration ClinicalTrials.gov NCT05095012.

show abstract

Section: Discussionmentioning

confidence: 99%

Health care impact of implementing a clinical pathway for acute care of pediatric concussion: a stepped wedge, cluster randomised trial

Yeates,

Barlow,

Wright

et al. 2023

Can J Emerg Med

View full text Add to dashboard Cite

show abstract

Readability of Postconcussion Home Care Instructions

Schellhase,

McIntosh,

Jennings-Collier

et al. 2024

International Journal of Athletic Therapy and Training

View full text Add to dashboard Cite

Patient education materials should be written at or below a fifth grade reading level. Postconcussion home care instructions outline what signs/symptoms warrant a visit to the emergency department and actions that should be taken/not taken by the caregiver. The purpose of this study was to determine the readability of postconcussion home care instructions provided by national organizations seen as setting the standard of care. Readability analyses were performed using the Readability Studio 2019 Standard Edition, by Oleander Software (Oleander Solutions). All postconcussion home care instructions were written above the recommended reading grade level. Poor comprehension of written material may lead to poor health outcomes; therefore, those organizations should consider amending handouts to meet the recommended reading level. Athletic trainers should examine the readability of home care instructions they provide, use both written and verbal instructions, and ensure caregiver understanding by using the skills in the Health Literacy Universal Precautions Toolkit.

show abstract

Factors of Parents-Reported Readiness for Hospital Discharge in Children with Acute Leukemia: A Cross-Sectional Study

Cai

Zheng

Wang

et al. 2022

Journal of Healthcare Engineering

View full text Add to dashboard Cite

Aim. The aim of this study is to investigate the existing status and to explore the influencing factors of parents-reported readiness for hospital discharge in children with acute leukemia (AL) in China and to propose optimizing pathways and recommendations of discharge readiness for clinical reference. Methods. A cross-sectional survey was conducted for the 122 children with AL who were discharged from the Second Affiliated Hospital and Yuying Children’s Hospital, Wenzhou Medical University; their parents were investigated by using the modified Chinese version of Readiness for Hospital Discharge Scale (RHDS) and Quality of Discharge Teaching Scale (QDTS). Data were collected between September 2020 and May 2021.Univariate analysis and multivariate logistic regression analysis were performed to explore the influencing factors of readiness for hospital discharge. Results. The 122 children with AL included 52 females and 70 males with mean age 6.08 years. The total RHDS score was 7.7 ± 1.2, and 68.9% of the participants had high readiness for hospital discharge (RHDS score >7). The total QDTS score was 7.6 ± 2.0. Parent marital status (OR = 4.86, 95% CI: 1.31–18.05), education status (OR = 3.86, 95% CI: 1.18–12.55), family per capita monthly income (OR = 1.08, 95% CI: 1.01–2.99), and high QDTS (OR = 1.56, 95% CI: 1.11–2.68) were risk factors for high RHDS. Conclusions. Our data suggest parents of children with AL had high readiness for hospital discharge and had the ability to take care of their children after discharge. Parental marital status, education status, QDTS score, and family per capita monthly income were independently associated with high RHDS.

show abstract

Improving Discharge Instructions Following a Concussion Diagnosis in the Pediatric Emergency Department: A Pre-post Intervention Study

Abstract: Supplemental Digital Content is available in the text.

Cited by 4 publications

References 32 publications

Health care impact of implementing a clinical pathway for acute care of pediatric concussion: a stepped wedge, cluster randomised trial

Health care impact of implementing a clinical pathway for acute care of pediatric concussion: a stepped wedge, cluster randomised trial

Readability of Postconcussion Home Care Instructions

Factors of Parents-Reported Readiness for Hospital Discharge in Children with Acute Leukemia: A Cross-Sectional Study

Contact Info

Product

Resources

About