Symptom-Guided Emergency Department Discharge Instructions for Children With Concussion

Brooks, Talia M.; Smith, Marissa M.; Silvis, Renee M.; Lerer, Trudy; Mulvey, Christine H.; Maitland, Ralynne; Dunn, Amy L.; Logan, Kelsey; Smith, Sharon R.

doi:10.1097/pec.0000000000000797

Cited by 9 publications

(15 citation statements)

References 23 publications

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“…1). Half of the included papers were observational studies ( n = 37) [23–59] and 47% ( n = 35) were either randomized controlled trials (RCT) or quasi-experimental studies [60–94]. Three qualitative studies were also included [95–97].…”

Section: Resultsmentioning

confidence: 99%

“…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].

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Section: Resultsmentioning

confidence: 99%

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

et al. 2019

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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.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Fig.…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2019

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“…Difficulty understanding discharge communication [30][31][32][33][34][35][36] Barrier "if caregivers encountered difficulty with using the instructions, he or she was then unable to effectively manage his or her child's condition in terms of restricting activity, seeking follow-up care, administering medications, and so on [34]. "…”

Section: Care Giver Levelmentioning

confidence: 99%

“…Intervention complexity [34,41,48,49] Barrier "Our intervention did not provide resources for time or additional personnel to support the improvement effort [41]. "…”

Section: Inter Venti On Levelmentioning

confidence: 99%

Using Behaviour Change Theories to Understand Pediatric Emergency Discharge Communication Interventions

Gallant

Bishop

Cassidy

et al. 2020

Preprint

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Background Interventions to improve discharge communication in emergency practice settings are inherently complex and incorporate multiple strategies aimed at patient, caregiver and healthcare provider behaviours. Behaviour change theories, including the capability-opportunity-motivation-behaviour (COM-B) model and Behaviour Change Technique Taxonomy version 1 (BCTTv1), provide consistent language for identifying and evaluating the active components of interventions. The objectives of this study were to: (1) identify common barriers and enablers to discharge communication interventions and (2) describe behaviour change techniques (BCTs) present in pediatric emergency discharge communication interventions aimed at patients, caregivers and health care providers. Methods We conducted a secondary analysis of 35 experimental and quasi-experimental studies included in a narrative synthesis of discharge communication interventions in pediatric emergency care. Included studies were reviewed to identify reported barriers and enablers to implementation and intervention effectiveness, which were then mapped to the COM-B model. Trained BCT coders independently coded intervention descriptions using the BCTTv1 as a coding framework. Consensus was used to resolve any discrepancies. BCTs were analyzed using descriptive statistics to determine the frequency of the 93 individual BCTs and 16 BCT categories for patient/caregiver and health care provider interventions. Results Barriers and enablers were identified at the patient/caregiver, health care provider, intervention and health system levels. Psychological capability was the most frequently coded COM-B component. Of the 33 studies that included BCTs, 29 interventions targeted patients or caregivers. A total of 20 different individual BCTs were identified across the interventions in the 33 studies. The number of BCTs identified in each study ranged from 1–9 BCTs, with most (n = 14, 42%) interventions containing one BCT. Reporting deficiencies were noted related to adequate details of intervention components and implementation fidelity. Conclusions The COM-B model and BCTTv1 proved to be useful tools to provide a foundational understanding of the common mechanisms used in pediatric discharge communication interventions. With only a fraction of the available BCTs were used in the included studies, future research is needed to explore the utility of other BCTs to address common implementation barriers and improve the effectiveness of discharge communication interventions.

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Recommendations for the Emergency Department Prevention of Sport-Related Concussion

Raukar

Devera

Ellis

et al. 2020

Annals of Emergency Medicine

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Symptom-Guided Emergency Department Discharge Instructions for Children With Concussion

Cited by 9 publications

References 23 publications

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

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

Using Behaviour Change Theories to Understand Pediatric Emergency Discharge Communication Interventions

Recommendations for the Emergency Department Prevention of Sport-Related Concussion

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