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

Janet A Curran,Samuel G Campbell,Andrea Bishop,Lisa Hartling,Andrea Murphy,Allyson J Gallant,Kate Macwilliams,Amy Plint,Amanda S Newton,Mona Jabbour,Jill Chorney,Roger Zemek,Shannon Macphee

doi:10.1186/s13643-019-0995-7

Abstract

BackgroundThe 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.MethodsWe 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.ResultsA 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.ConclusionExisting 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 registrationPROSPERO registration number: CRD42014007106.

Highlights

The majority of children receiving care in the emergency department (ED) are discharged home, making discharge communication a key component of quality emergency care
Comprehension of discharge communication has been shown to be an important factor in promoting adherence to discharge instructions and preventing unnecessary return visits; comprehension is rarely assessed in practice [9]
We embedded an integrated knowledge translation approach in our review, whereby we met with key knowledge users (e.g., ED clinicians, administrators, parents, and researchers) during each stage of the review to strengthen the relevancy of our research questions and tailor our recommendations

Summary

Introduction

The discharge process in a pediatric emergency department (ED) can introduce vulnerability for parents and caregivers Attention to this phenomenon is critical given that following a visit to the ED the majority of children are discharged home under the care of their parents [1, 2]. The discharge process should include communication of important information about the child’s illness, verification of comprehension, and tailoring of the discharge instructions to address areas of misunderstanding [6] This is not always the parents’ experience, and evidence supports that poor quality ED discharge communication can impact subsequent health care utilization, including unscheduled return visits to the ED [7, 8]. A number of factors are known to impact comprehension including quality of the communication provided [10], health literacy, numeracy, and reading ability [11,12,13]

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