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


BACKGROUND
ClinicalTrials.gov NCT01361932 http://clinicaltrials.gov/ct2/show/NCT01361932?term=nct01361932&rank=1.
The Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada ; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada ; The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
Clare L
CL
Atzema
Peter C
PC
Austin
Libo
L
Wu
Michael
M
Brzozowski
Michael J
MJ
Feldman
Michael
M
McDonnell
Laurie
L
Mazurik
D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D010351:Patient Discharge; D017060:Patient Satisfaction; D014741:Video Recording