Development and feasibility testing of the Pediatric Emergency Discharge Interaction Coding Scheme.

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.