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Development and feasibility testing of the Pediatric Emergency Discharge Interaction Coding Scheme
Janet A Curran1, Alexandra Taylor2, Jill Chorney3
1Department of Emergency Medicine, IWK Health Centre, Halifax, NS, Canada.
Insights
This study developed the Pediatric Emergency Discharge Interaction Coding Scheme (PEDICS) to analyze communication between healthcare providers and caregivers in pediatric emergency departments. The tool identified communication deficits that may affect adherence to discharge instructions.
Area of Science:
- Pediatric Emergency Medicine
- Health Communication
- Quality Improvement
Background:
- Effective discharge communication is crucial for high-quality emergency care.
- A knowledge gap exists regarding the specifics of discharge communication in pediatric emergency departments.
- This study aimed to address this gap by developing a method to describe these interactions.
Purpose of the Study:
- To develop and pilot-test a coding scheme for characterizing discharge communication.
- To specifically examine interactions between health-care providers (HCPs) and caregivers of children in the emergency department (ED).
- To create a tool for mapping communication patterns and identifying potential areas for improvement.
Main Methods:
- Developed the Pediatric Emergency Discharge Interaction Coding Scheme (PEDICS) and manual through literature review and iterative refinement.
- Pilot-tested PEDICS via direct observation of HCPs in an urban pediatric ED.
- Included inter-rater reliability assessments and team consensus in the development process.
Main Results:
- Conducted 329 patient observations across 50 shifts, resulting in a 41-element coding scheme (PEDICS).
- Achieved Kappa scores > 0.60 for most communication elements, indicating good reliability.
- Found that HCPs initiated most communication, with 'Introduction' elements being most frequent and 'Social Concerns' least frequent.
Conclusions:
- The PEDICS tool effectively maps discharge communication patterns between HCPs and caregivers in pediatric EDs.
- Pilot testing revealed specific communication deficits that could impact patient adherence to discharge instructions.
- Further validation of PEDICS with diverse HCP samples is recommended to enhance its utility.
Background:
Discharge communication is an important aspect of high-quality emergency care. This study addresses the gap in knowledge on how to describe discharge communication in a paediatric emergency department (ED).
Objective:
The objective of this feasibility study was to develop and test a coding scheme to characterize discharge communication between health-care providers (HCPs) and caregivers who visit the ED with their children.
Design:
The Pediatric Emergency Discharge Interaction Coding Scheme (PEDICS) and coding manual were developed following a review of the literature and an iterative refinement process involving HCP observations, inter-rater assessments and team consensus.
Setting And Participants:
The coding scheme was pilot-tested through observations of HCPs across a range of shifts in one urban paediatric ED.
Main Variables Studied:
Overall, 329 patient observations were carried out across 50 observational shifts. Inter-rater reliability was evaluated in 16% of the observations. The final version of the PEDICS contained 41 communication elements.
Results:
Kappa scores were greater than .60 for the majority of communication elements. The most frequently observed communication elements were under the Introduction node and the least frequently observed were under the Social Concerns node. HCPs initiated the majority of the communication.
Conclusion:
Pediatric Emergency Discharge Interaction Coding Scheme addresses an important gap in the discharge communication literature. The tool is useful for mapping patterns of discharge communication between HCPs and caregivers. Results from our pilot test identified deficits in specific areas of discharge communication that could impact adherence to discharge instructions. The PEDICS would benefit from further testing with a different sample of HCPs.
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