Speak fast, use jargon, and don't repeat yourself: a randomized trial assessing the effectiveness of online videos to supplement emergency department discharge instructions

Clare L Atzema, Peter C Austin, Libo Wu, Michael Brzozowski, Michael J Feldman, Michael McDonnell, Laurie Mazurik, Clare L Atzema, Peter C Austin, Libo Wu, Michael Brzozowski, Michael J Feldman, Michael McDonnell, Laurie Mazurik

Abstract

Background: Emergency 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.

Methods: In 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.

Results: Among 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).

Conclusions: In 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 https://ichgcp.net/clinical-trials-registry/NCT01361932?term=nct01361932&rank=1.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. CONSOSRT flow diagram.
Figure 1. CONSOSRT flow diagram.

References

    1. Chan B, Schull M, Schultz S (2001) Atlas Report: Emergency Department Services in Ontario. Available: . Accessed 22 August 2012.
    1. Ambulatory and Hospital Care Statistics Branch (2013) National. Hospital Ambulatory Medical Care Survey: 2009 Emergency Department Summary Tables. Available: . Accessed 4 April 2011.
    1. Department of Health & Human Services (DHHS), Centers for Medicare & Medicaid Services (CMS) (2008) Revise Appendix A, "Interpretive Guidelines for Hospitals. Transmittal 37". Available: . Accessed 19 February 2013.
    1. Jack BW, Chetty VK, Anthony D, Greenwald JL, Sanchez GM et al. (2009) A reengineered hospital discharge program to decrease rehospitalization: a randomized trial. Ann Intern Med 150: 178-187. doi:10.7326/0003-4819-150-3-200902030-00007. PubMed: .
    1. VanSuch M, Naessens JM, Stroebel RJ, Huddleston JM, Williams AR (2006) Effect of discharge instructions on readmission of hospitalised patients with heart failure: do all of the Joint Commission on Accreditation of Healthcare Organizations heart failure core measures reflect better care? Qual Saf Health Care 15: 414-417. doi:10.1136/qshc.2005.017640. PubMed: .
    1. Rhodes KV, Vieth T, He T, Miller A, Howes DS et al. (2004) Resuscitating the physician-patient relationship: emergency department communication in an academic medical center. Ann Emerg Med 44: 262-267. doi:10.1016/j.annemergmed.2004.02.035. PubMed: .
    1. Derlet R, Richards J, Kravitz R (2001) Frequent overcrowding in U.S. emergency departments. Acad Emerg Med 8: 151-155. doi:10.1111/j.1553-2712.2001.tb01280.x. PubMed: .
    1. Fatovich DM, Nagree Y, Sprivulis P (2005) Access block causes emergency department overcrowding and ambulance diversion in Perth, Western Australia. Emerg Med J 22: 351-354. doi:10.1136/emj.2004.018002. PubMed: .
    1. Miró O, Antonio MT, Jiménez S, De Dios A, Sánchez M et al. (1999) Decreased health care quality associated with emergency department overcrowding. Eur J Emerg Med 6: 105-107. doi:10.1097/00063110-199906000-00003. PubMed: .
    1. Rowe B, Bond K, Ospina B, Blitz S, Afilalo M et al. (2006) Frequency, determinents, and impact of overcrowding on emergency departments in Canada: A national survey of emergency department directors. Technology Report No 67.3. Available: . Accessed 4 April 2011.
    1. Engel KG, Heisler M, Smith DM, Robinson CH, Forman JH et al. (2009) Patient comprehension of emergency department care and instructions: are patients aware of when they do not understand? Ann Emerg Med 53: 454-461. doi:10.1016/j.annemergmed.2008.05.016. PubMed: .
    1. Mace CA (1962) Psychology of Study [Revised Edition]. Harmondsworth: Penguin.
    1. the World Bank (2012) Internet users (per 100 people). Available: . Accessed 19 February 2013.
    1. Dalkey NC (1969) The Delphi method: an experimental application of group opinion. Rand Corporation. Available: . Accessed 18 June 2013.
    1. Lindsay P, Schull M, Bronskill S, Anderson G (2002) The development of indicators to measure the quality of clinical care in emergency departments following a modified-delphi approach. Acad Emerg Med 9: 1131-1139. doi:10.1111/j.1553-2712.2002.tb01567.x. PubMed: .
    1. Beveridge R, Clarke B, Janes L et al. (1998) Implementation Guidelines for The Canadian Emergency Department Triage & Acuity Scale (CTAS). Available: . Accessed 19 February 2013
    1. Atzema CL, Stefan RA, Saskin R, Michlik G, Austin PC (2012) Physician-Rated Utility of Procedure Videos for Teaching Procedures in the Emergency Department, Overall and during Emergency Department Crowding. Int J Clin Med 3: 758-764. doi:10.4236/ijcm.2012.37A133.
    1. Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33: 159-174. doi:10.2307/2529310. PubMed: .
    1. Clarke C, Friedman SM, Shi K, Arenovich T, Monzon J et al. (2005) Emergency department discharge instructions comprehension and compliance study. CJEM 7: 5-11. PubMed: .
    1. Spandorfer JM, Karras DJ, Hughes LA, Caputo C (1995) Comprehension of discharge instructions by patients in an urban emergency department. Ann Emerg Med 25: 71-74. doi:10.1016/S0196-0644(95)70358-6. PubMed: .
    1. Institute of Medicine (2006) Hospital-Based Emergency Care: At the Breaking Point. Available: . Accessed 19 February 2013.
    1. Kawano T, Nishiyama K, Anan H, Tujimura Y (2013) Direct relationship between aging and overcrowding in the ED, and a calculation formula for demand projection: a cross-sectional study. Emerg Med J (. (2013)) PubMed: .
    1. Austin PE, Matlack R, Dunn KA, Kesler C, Brown CK (1995) Discharge instructions: do illustrations help our patients understand them? Ann Emerg Med 25: 317-320. doi:10.1016/S0196-0644(95)70286-5. PubMed: .
    1. Johnson A, Sandford J, Tyndall J (2003) Written and verbal information versus verbal information only for patients being discharged from acute hospital settings to home. Cochrane Database Syst Rev CD: 003716 PubMed: .
    1. Waisman Y, Siegal N, Siegal G, Amir L, Cohen H et al. (2005) Role of diagnosis-specific information sheets in parents' understanding of emergency department discharge instructions. Eur J Emerg Med 12: 159-162. doi:10.1097/00063110-200508000-00003. PubMed: .
    1. Papa L, Seaberg DC, Rees E, Ferguson K, Stair R et al. (2008) Does a waiting room video about what to expect during an emergency department visit improve patient satisfaction? CJEM 10: 347-354. PubMed: .
    1. Choi S, Ahn J, Lee D, Jung Y (2009) The Effectiveness of Mobile Discharge Instruction Videos (MDIVs) in communicating discharge instructions to patients with lacerations or sprains. South Med J 102: 239-247. doi:10.1097/SMJ.0b013e318197f319. PubMed: .
    1. Waisman Y, Siegal N, Chemo M, Siegal G, Amir L et al. (2003) Do parents understand emergency department discharge instructions? A survey analysis. Isr Med Assoc J 5: 567-570. PubMed: .
    1. Clark PA, Drain M, Gesell SB, Mylod DM, Kaldenberg DO et al. (2005) Patient perceptions of quality in discharge instruction. Patient Educ Couns 59: 56-68. doi:10.1016/j.pec.2004.09.010. PubMed: .

Source: PubMed

スポンサーと協力者

医学的状態

薬物療法

3
購読する