UNDERSTANDING DISCHARGE COMMUNICATION BEHAVIOURS IN PEDIATRIC EMERGENCY CARE
Notice bibliographique
Résumé
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.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,003 | 0,019 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».