Discharge communication practices in pediatric emergency care: a systematic review and narrative synthesis

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. Electronic supplementary material The online version of this article (10.1186/s13643-019-0995-7) contains supplementary material, which is available to authorized users.

Using Behaviour Change Theories to Understand Pediatric Emergency Discharge Communication Interventions

“…We conducted a secondary analysis of 35 experimental and quasi-experimental studies included in a systematic review and narrative synthesis of discharge communication in pediatric emergency care to gain a better understanding of the behaviours related to discharge communication and the characteristics of existing interventions [23]. A full description of the narrative synthesis protocol [25] and findings [23] can be found elsewhere. Coders were blinded to the intervention function classification completed during the narrative synthesis.…”

“…Effective discharge communication interventions include standardizing content delivered through both verbal and written modes, and ensuring patient comprehension and recall through strategies such as demonstration of the behaviour, prompts, and social support [21,22]. Findings from a recent systematic review and narrative synthesis of pediatric discharge communication found that the majority of interventions across both acute and chronic illness presentations were aimed at improving caregiver comprehension of health information [23]. Further, many of these discharge communication interventions include multiple intervention components (e.g., education, reminders) and targets (e.g., patient and family, health care provider and system), making it difficult to discern which intervention components, or interaction of multiple components, resulted in the measured outcome [2,23,24].…”

Effect of Family-centered Care Interventions on Motor and Neurobehavior Development of Very Preterm Infants: A Protocol of Systematic Review

“…A review on the effects of early intervention for very preterm infants found that early intervention strategies addressing the relationship between parent-child was effective when compared to interventions centered on the child or the parent alone. It is necessary to educate and involve the family in the treatment of infants to have a greater effect on their developmental outcomes [11].…”

“…Family-centered care (FCC) is described as a healthcare approach that involves planning, delivery, and evaluation centered on equally positive relationships among families, healthcare providers, and patients [13]. FCC's values include family care, inclusive family engagement, interaction, empathy for and integrity of families, and knowledge transformation [11]. It has been implemented in developed and a few of the developing countries [14].…”

Using Behaviour Change Theories to Understand Pediatric Emergency Discharge Communication Interventions

“…Effective discharge communication interventions include standardizing content delivered through both verbal and written modes, and ensuring patient comprehension and recall through strategies such as demonstration of the behaviour, prompts, and social support [21,22]. Findings from a recent systematic review and narrative synthesis of pediatric discharge communication found that the majority of interventions across both acute and chronic illness presentations were aimed at improving caregiver comprehension of health information [23]. Further, many of these discharge communication interventions include multiple intervention components (e.g., education, reminders) and targets (e.g., patient and family, health care provider and system), making it di cult to discern which intervention components, or interaction of multiple components, resulted in the measured outcome [2,23,24].…”