An Investigation Into the Provision and Parents’ Understanding of Discharge Information to Assist in Managing Their Child Following Discharge from the Emergency Department of an Australian Hospital: A Mixed Methods Study.

Abstract

Introduction Providing useful discharge information is a key priority for Emergency Department staff, especially when children are discharged from hospital because they are vulnerable, relying on their parents or guardians for the care. If these carers do not fully understand the discharge information, their child’s health and wellbeing may be compromised. For example, parents may make medication errors, with a risk that their child may not receive the appropriate dosage at the right time. Children may experience oligoanalgesia or be over-medicated for pain. Parents may not understand the signs that indicate they need to seek further medical attention for their child or return unnecessarily to busy EDs, which may increase health costs. A better understanding of the provision of discharge information in ED may reduce these risks. Aims The aim of this thesis is to explore the provision of discharge information to parents to assist in managing their child’s care post discharge from the ED. This thesis explores: 1. Factors in the ED that support the provision and understanding of discharge information to parents. 2. ED nurses’ perceptions of factors that influence parents’ understanding of discharge information 3. Parents’ perceptions of the discharge information they received from the ED. Methods This thesis has been guided by the philosophy of pragmatism and the Donabedian Model of Quality of Care conceptual framework. The mixed methods convergent parallel design used for this research, conceptualised as a “triangulation” design where quantitative and qualitative data are used to obtain triangulated results about a single topic. Triangulation data were collected through multiple methods and from four different studies: (i) document analysis; (ii) non-participant observation in the ED; (iii) focus groups with ED nurses; and (iv) a survey of parents of children attending the ED. The setting for data collection was a children’s ED at a tertiary referral hospital in Queensland, Australia. Data from each method were analysed separately, and then compared and integrated. Descriptive methods were used to analyse quantitative data, while thematic analysis was applied to qualitative data. Findings For the first time, the provision of the discharge information for parents in Australian ED has been explored using the Donabedian Model of Quality of care. This model provides direction in exploring the structural issues, processes, and outcomes domain of the provision discharge information. A thematic analysis of the findings from the 4 studies identified three key circumstances under which parents’ understanding of discharge information could be compromised or promoted. These circumstances are reflected in three themes: (i) the structures that support the provision of discharge information resources for parents; (ii) the impact of waiting times; and (iii) the structures and processes that underpin the model of care in the ED, and which guide the role of the ED staff in minimising the risk of parents’ misunderstanding information provided to them. Conclusion This thesis has investigated the structures, processes and outcomes relating to parents’ understanding of discharge information in an ED setting. Recommendations on strategies and future research to improve the provision of discharge information have been outlined. Ultimately, the findings from this study could inform future research endeavours to help ED staff and parents provide a high quality of care for children following discharge from the ED.