UNDERSTANDING DISCHARGE COMMUNICATION BEHAVIOURS IN PEDIATRIC EMERGENCY CARE

Abstract

Abstract BACKGROUND One of the most important transitions in the continuum of care for children is discharge to home. However, optimal discharge communication between healthcare providers and parents who present to the emergency department (ED) with their children is not well understood. Current research regarding discharge communication is equivocal and predominantly focused on evaluating different delivery formats or strategies with little attention given to communication behaviours or the context in which the communication occurs. OBJECTIVES The aim of this mixed methods study was to characterize the process and structure of discharge communication in a paediatric ED context. DESIGN/METHODS Real-time video observation methods were used in two academic paediatric EDs in Canada. Parents who presented with their child to the ED with one of six illness presentations, a Canadian Triage Acuity Score of 3 to 5, and English speaking, were eligible to participate. All ED physicians, learners, and clinical staff members were also eligible to participate. Provider-parent communication was analyzed using the Roter Interaction Analysis System (RIAS) to code each utterance. Parent comprehensive was evaluated using a follow-survey 72 hours after discharge. RESULTS A total of 106 unique ED visits involving six illness presentations: abdominal pain (n=23), asthma (n=6), bronchiolitis (n=4), diarrhea/vomiting (n=20), fever (n=27), and minor head injury (n=26) were video recorded. The average length of stay in the ED was 3 hours, with an average of three provider-parent interactions per visit. Interactions ranged in time from less than one minute to 29 minutes, with an average of six minutes per interaction. A total of 34,544 unique utterances were coded across all interactions. The majority of patient visits were first-time visits for the illness presentation (63.2%). Physicians most commonly gave medical information (22.9%) or asked close-ended medical questions (9.4%), whereas nurses most commonly gave orientation instructions (20.9%). Medical trainees were most likely to employ active listening techniques (e.g. back channels, 14.2%). Communication that included post-discharge instructions for parents comprised 8.5% of all utterances. Overall, providers infrequently assessed parental understanding of information (2.0%). Parent satisfaction with the amount of information communicated was generally high (89.6% agreed or strongly agreed). CONCLUSION This is the first discharge communication study to be conducted in a paediatric ED context using video observation methods. Provider-parent communication was predominantly characterized by the exchange of medical information, with little time devoted to adequately preparing parents to care for their child at home. Greater assessment of parental comprehension is needed to ensure that parents understand important instructions and know when to seek further care.