Improving Discharge Instructions in a Pediatric Emergency Department: Impact of a Quality Initiative.
BACKGROUND
Effective communication between physician and patient is essential to optimize care after discharge from the emergency department (ED). Written discharge care instructions (DCI) complement verbal instructions and have been shown to improve communication and patient management. In 2012, Centers for Medicare and Medicaid Services proposed a quality measure (OP-19) that assesses compliance with key elements considered essential for high-quality written DCI.


OBJECTIVE
To evaluate the impact of a QI intervention on improving quality of written DCI in a pediatric emergency department (PED).


METHODS
A QI initiative was conducted at a tertiary PED with greater than 60,000 annual visits. Based on Centers for Medicare and Medicaid Services OP-19 measure and group consensus, 8 elements were defined a priori as requisites for good quality DCI. These elements are:Providers reviewed a random sample of DCI of patients. Proportion of DCI that had each element documented was compared between preintervention phase (PRE) and postintervention phase (POST).


RESULTS
Three hundred twenty-nine DCI (PRE) and 1434 DCI (POST) were reviewed. The POST DCI showed statistically significant improvement for each of the 8 elements. The bundle measure (proportion containing all 8 elements) increased from 23% (PRE) to 79% (POST) (P < 0.001).


CONCLUSIONS
The ED DCI improved in all 8 elements after a QI intervention. A detailed DCI at ED discharge enhances the patient's ability to comply with postdischarge treatment plan. Further studies are needed to evaluate the impact of improving DCI on ED return rates and other outcomes.
From the *Emory University School of Medicine; †Children's Healthcare of Atlanta, Atlanta, GA.
Bolanle
B
Akinsola
John
J
Cheng
April
A
Zmitrovich
Naghma
N
Khan
Shabnam
S
Jain
D002648:Child; D004282:Documentation / Q000592:standards; D004636:Emergency Service, Hospital / Q000592:standards*; D005260:Female; D006302:Health Services Research; D006801:Humans; D008297:Male; D010351:Patient Discharge / Q000592:standards*; D058996:Quality Improvement; D014481:United States