Speak Fast, Use Jargon, and Don’t Repeat Yourself: A Randomized Trial Assessing the Effectiveness of Online Videos to Supplement Emergency Department Discharge Instructions

Abstract

BackgroundEmergency department discharge instructions are variably understood by patients, and in the setting of emergency department crowding, innovations are needed to counteract shortened interaction times with the physician. We evaluated the effect of viewing an online video of diagnosis-specific discharge instructions on patient comprehension and recall of instructions.MethodsIn this prospective, single-center, randomized controlled trial conducted between November 2011 and January 2012, we randomized emergency department patients who were discharged with one of 38 diagnoses to either view (after they left the emergency department) a vetted online video of diagnosis-specific discharge instructions, or to usual care. Patients were subsequently contacted by telephone and asked three standardized questions about their discharge instructions; one point was awarded for each correct answer. Using an intention-to-treat analysis, differences between groups were assessed using univariate testing, and with logistic regression that accounted for clustering on managing physician. A secondary outcome measure was patient satisfaction with the videos, on a 10-point scale.ResultsAmong 133 patients enrolled, mean age was 46.1 (s.d.D. 21.5) and 55% were female. Patients in the video group had 19% higher mean scores (2.5, s.d. 0.7) than patients in the control group (2.1, s.d. 0.8) (p=0.002). After adjustment for patient age, sex, first language, triage acuity score, and clustering, the odds of achieving a fully correct score (3 out of 3) were 3.5 (95% CI, 1.7 to 7.2) times higher in the video group, compared to the control group. Among those who viewed the videos, median rating of the videos was 10 (IQR 8 to 10).ConclusionsIn this single-center trial, patients who viewed an online video of their discharge instructions scored higher on their understanding of key concepts around their diagnosis and subsequent care. Those who viewed the videos found them to be a helpful addition to standard care.Trial Registration ClinicalTrials.gov NCT01361932 http://clinicaltrials.gov/ct2/show/NCT01361932?term=nct01361932&rank=1

Concussion: Improving Nurses' Knowledge in the Emergency Department

“…Good discharge instructions prevent repeat ED visits and subsequent hospitalizations (Atzema et al 2013). Nurses working in the ED have a need to stay up-to-date on evidence based treatments including current concussion management recommendations.…”

“…The Centers for Medicare and Medicaid Services (CMS) support compliance measures for written discharge instructions in hospitalized patients; however, ED discharge is not specifically addressed (Atzema et al, 2013). Good discharge instructions prevent repeat ED visits and subsequent hospitalizations, however the time it takes to provide thorough instructions may be difficult (Atzema et al 2013). (Borg et al, 2004).…”

“…A study by Atzema et al (2013) Study limitations include a single site study with slightly lower proportion of low socioeconomic status participants and everyone had internet access. Also the research assistant was not blinded to the group.…”

“…The intervention group not only had improved understanding of their discharge instructions but also had a high level of satisfaction with regard to their comprehension. Given that an average ED discharge lasts 76 seconds, utilizing technology to offset communication deficiencies can achieve improved patient comprehension (Atzema et al, 2013).…”

“…The CDC's HEADS UP campaign (2015) recommends using the Acute Concussion Evaluation (ACE) care plan which has evidence-based discharge instructions that can be used by nurses discharging concussions patients. Educating ED nurses about concussion is crucial because ED nurses play a key role in helping to improve patient health outcomes through patient teaching (Atzema et al, 2013). The purpose of this project is to increase ED nurses' knowledge of concussion/MTBI and the current CDC recommended education for patients and families discharged home.…”