Related Experiment Video
Updated: Mar 15, 2026

A Modified Sonographic Algorithm for Image Acquisition in Life-Threatening Emergencies in the Critically Ill Newborn
Published on: April 7, 2023
Improving Discharge Instructions in a Pediatric Emergency Department: Impact of a Quality Initiative
Bolanle Akinsola1, John Cheng, April Zmitrovich
1From the *Emory University School of Medicine; †Children's Healthcare of Atlanta, Atlanta, GA.
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.
More Related Videos
Related Concept Videos
Discharge Summary Forms
Here's a detailed look at the key components and guidelines for preparing a discharge summary:
Guidelines for Nursing Documentation I
Factual:
The following points emphasize the significance of upholding accurate and unbiased documentation in healthcare.
Pharmacokinetics in Pediatric Patients: Drug Excretion
Types of Reports III: Telephone and Verbal Reports
Here's an overview of each type:
Telephone Orders
Drug Dosing: Infants and Children
Methods of Documentation III: PIE

