Abstract:Many leaflets did not include important information recommended by SIGN guidelines. There was considerable variation in the quality and clarity of written discharge advice provided. This may reduce the ability of parents to recognize rare but serious complications. It is recommended that a standardized HI information leaflet based on SIGN guidelines be used across all Scottish EDs.
“…Although included studies focused on a variety of illness presentations, asthma ( n = 20) was the most common [27, 29, 39, 42, 46, 61, 62, 65, 67, 70, 75, 77, 79–83, 85, 89, 90]. Other common illnesses were minor head injury ( n = 12) [30, 34, 36, 44, 48, 50, 51, 56, 58, 68, 86, 94] and fever ( n = 9) [35, 46, 64, 67, 68, 71, 72, 78, 88]. Outcomes varied across included studies but primarily involved improving parent adherence with discharge instructions or follow-up appointments ( n = 12) [60, 61, 66, 75, 77, 81–85, 90, 93], improving parent knowledge of illness treatment ( n = 7) [63, 65, 67, 68, 70–72], and reducing unnecessary return ED visits ( n = 5) [62, 64, 69, 88, 89].…”
Section: Resultsmentioning
confidence: 99%
“…Outcomes varied across included studies but primarily involved improving parent adherence with discharge instructions or follow-up appointments ( n = 12) [60, 61, 66, 75, 77, 81–85, 90, 93], improving parent knowledge of illness treatment ( n = 7) [63, 65, 67, 68, 70–72], and reducing unnecessary return ED visits ( n = 5) [62, 64, 69, 88, 89]. All studies were published from 1979 to 2018, with just over half ( n = 41) of the studies published since 2009 [23–25, 30, 32–34, 37, 40, 42, 44–52, 55, 56, 59, 61, 64–68, 71–73, 75, 76, 79, 81, 83, 85, 92, 94, 96, 97]. Fig.…”
Section: Resultsmentioning
confidence: 99%
“…The average reading level of the resources was 8.2, compared to the ideal level of 5–6.Hawley et al 2012 [34]To evaluate printed resources provided to parents of children with head injuries.Cross-sectional studyAnalytical cross-sectional studyUK211 hospitals provided copies of their printed head injury resources for the study.The quality of information provided in the printed resources varied. Thirty-three resources received a perfect score and an additional 33 resources were considered to include questionable information.Qureshi et al 2013 [44]To evaluate written discharge information provided to parents of children with head injuries with the recommendations from the Scottish Intercollegiate Guideline Network (SIGN).Cross-sectional studyAnalytical cross-sectional studyScotland36 hospitals provided copies of the written head injury information.The quality of written information for head injuries varied widely, with anywhere from 4 to 20 of the 20 SIGN urgent symptoms to monitor being listed (median score of 10/20 guidelines identified). Two leaflets contained the majority of head injury guidelines and four pamphlets provided erroneous or unclear details.Thomas et al 2017 [51]To determine the effect of reinforcing written discharge communication with verbal instruction on parents’ recall of discharge communication.Nested observational studyAnalytical cross-sectional studyUSA93 parents of pediatric patients presenting to the ED with mild traumatic brain injury.Receiving verbal instructions in addition to written handouts on post-concussion care was associated with improved recall of instructions (67% vs 44%; p < 0.05).Cheng et al 2002 [27]To assess factors associated with metered-dose inhaler spacers (MDIS) use at home in children with asthma who received asthma education during their ED visit.Prospective observationalAnalytical cross-sectional studyAustralia73 parents of children (12 months–16 years) who attended a pediatric ED with asthma.Compliance with MDIS use at home was significantly higher when MDIS was used during the ED visit ( p = 0.05), the parents received written instructions on how to use MDIS at home ( p = 0.003), and receiving a smaller sized spacer ( p ≤ 0.001).…”
Section: Resultsmentioning
confidence: 99%
“…However, Macy et al (2011) noted that even the use of video education can be hindered during times of high patient volumes [65]. Ideal structures support discharge communication that is consistent and comprehensive yet succinct and relevant [23, 44, 97]. ED team practice norms regarding discharge communication [42, 78] and roles in the ED specifically dedicated to discharge communication may assist with consistent and reliable delivery [27, 39, 76].…”
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.
Electronic supplementary material
The online version of this article (10.1186/s13643-019-0995-7) contains supplementary material, which is available to authorized users.
“…Although included studies focused on a variety of illness presentations, asthma ( n = 20) was the most common [27, 29, 39, 42, 46, 61, 62, 65, 67, 70, 75, 77, 79–83, 85, 89, 90]. Other common illnesses were minor head injury ( n = 12) [30, 34, 36, 44, 48, 50, 51, 56, 58, 68, 86, 94] and fever ( n = 9) [35, 46, 64, 67, 68, 71, 72, 78, 88]. Outcomes varied across included studies but primarily involved improving parent adherence with discharge instructions or follow-up appointments ( n = 12) [60, 61, 66, 75, 77, 81–85, 90, 93], improving parent knowledge of illness treatment ( n = 7) [63, 65, 67, 68, 70–72], and reducing unnecessary return ED visits ( n = 5) [62, 64, 69, 88, 89].…”
Section: Resultsmentioning
confidence: 99%
“…Outcomes varied across included studies but primarily involved improving parent adherence with discharge instructions or follow-up appointments ( n = 12) [60, 61, 66, 75, 77, 81–85, 90, 93], improving parent knowledge of illness treatment ( n = 7) [63, 65, 67, 68, 70–72], and reducing unnecessary return ED visits ( n = 5) [62, 64, 69, 88, 89]. All studies were published from 1979 to 2018, with just over half ( n = 41) of the studies published since 2009 [23–25, 30, 32–34, 37, 40, 42, 44–52, 55, 56, 59, 61, 64–68, 71–73, 75, 76, 79, 81, 83, 85, 92, 94, 96, 97]. Fig.…”
Section: Resultsmentioning
confidence: 99%
“…The average reading level of the resources was 8.2, compared to the ideal level of 5–6.Hawley et al 2012 [34]To evaluate printed resources provided to parents of children with head injuries.Cross-sectional studyAnalytical cross-sectional studyUK211 hospitals provided copies of their printed head injury resources for the study.The quality of information provided in the printed resources varied. Thirty-three resources received a perfect score and an additional 33 resources were considered to include questionable information.Qureshi et al 2013 [44]To evaluate written discharge information provided to parents of children with head injuries with the recommendations from the Scottish Intercollegiate Guideline Network (SIGN).Cross-sectional studyAnalytical cross-sectional studyScotland36 hospitals provided copies of the written head injury information.The quality of written information for head injuries varied widely, with anywhere from 4 to 20 of the 20 SIGN urgent symptoms to monitor being listed (median score of 10/20 guidelines identified). Two leaflets contained the majority of head injury guidelines and four pamphlets provided erroneous or unclear details.Thomas et al 2017 [51]To determine the effect of reinforcing written discharge communication with verbal instruction on parents’ recall of discharge communication.Nested observational studyAnalytical cross-sectional studyUSA93 parents of pediatric patients presenting to the ED with mild traumatic brain injury.Receiving verbal instructions in addition to written handouts on post-concussion care was associated with improved recall of instructions (67% vs 44%; p < 0.05).Cheng et al 2002 [27]To assess factors associated with metered-dose inhaler spacers (MDIS) use at home in children with asthma who received asthma education during their ED visit.Prospective observationalAnalytical cross-sectional studyAustralia73 parents of children (12 months–16 years) who attended a pediatric ED with asthma.Compliance with MDIS use at home was significantly higher when MDIS was used during the ED visit ( p = 0.05), the parents received written instructions on how to use MDIS at home ( p = 0.003), and receiving a smaller sized spacer ( p ≤ 0.001).…”
Section: Resultsmentioning
confidence: 99%
“…However, Macy et al (2011) noted that even the use of video education can be hindered during times of high patient volumes [65]. Ideal structures support discharge communication that is consistent and comprehensive yet succinct and relevant [23, 44, 97]. ED team practice norms regarding discharge communication [42, 78] and roles in the ED specifically dedicated to discharge communication may assist with consistent and reliable delivery [27, 39, 76].…”
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.
Electronic supplementary material
The online version of this article (10.1186/s13643-019-0995-7) contains supplementary material, which is available to authorized users.
“…Inform the patient that mTBI patient increased an risk of postraumatic seizures in immediate (within 24 hours after injury), early (within 1 to 7 days after injury), or late period (more than 7 days after injury). If the patients have open head injury, informed them about wound infection signs such as redness, swelling, or foul drainage (Bay & Strong, 2011;Curran et al, 2016;Engel et al, 2012;Ismail et al, 2015;Kornburger et al, 2013;Qureshi et al, 2013;Zavala et al, 2011).…”
This study aims to review the literature on educational interventions for the discharge of mild traumatic brain injury (mTBI) patients in the Emergency Room (IGD). Database searches were performed based on PICO queries and keywords. using ProQuest, ScienceDirect, Scopus, and PubMed for the period 2012-2019. Ten studies were reviewed. The findings revealed the contents of discharge information for mTBI patients including diagnosis, signs and symptoms, treatment and medication, pain management, home care, and ED return instructions. Four methods of discharge intervention are commonly used in the ED; written, spoken, animated and moving videos, and printed instructions measured over two time periods, either pre-discharge in the ED or follow-up 1-2 weeks post-discharge at home. In conclusion, combined teaching was more effective in terms of level of knowledge, understanding, and ED repeat visits.
Keywords: Discharge education, Emergency, Minor Traumatic Brain Injury
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