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Published on: January 20, 2019
Improving Discharge Instructions Following a Concussion Diagnosis in the Pediatric Emergency Department: A Pre-post
Aaron M Yengo-Kahn1,2,3, Natalie Hibshman2,3,4, Michael Bezzerides3,4
1Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tenn.
Insights
A simple intervention improved pediatric concussion discharge instructions, increasing return-to-play and return-to-learn guidance. However, sustained improvements require further attention to maintain progress.
Area of Science:
- Pediatric Emergency Medicine
- Neurology
- Public Health
Background:
- Pediatric emergency departments often provide incomplete concussion discharge instructions.
- This can negatively impact patient recovery and management.
- A need exists for effective interventions to improve instruction quality.
Purpose of the Study:
- To assess the impact of a simple intervention on pediatric concussion discharge instruction completeness.
- To evaluate improvements in return-to-play (RTP) and return-to-learn (RTL) instructions.
- To determine the sustainability of intervention effects.
Main Methods:
- A pre/post intervention study involving 935 pediatric concussion patients (ages 5-19).
- Intervention included provider education and standardized electronic health record discharge instructions.
- Outcomes measured: presence of RTP, RTL, follow-up recommendations, and complete discharge.
Main Results:
- Post-intervention, RTP instructions increased from 59% to 87%, and RTL from 3% to 60%.
- Complete discharge rates rose from 2% to 45%.
- Sustained improvements were observed only for RTP instructions; RTL and complete discharge rates declined over time.
Conclusions:
- Peer education and standardized templates are effective, low-cost methods to enhance pediatric concussion discharge readiness.
- Sustaining improvements in return-to-learn and complete discharge requires ongoing effort.
- Further research is needed to maintain progress in academic trauma centers.
Introduction:
Many children are discharged from the pediatric emergency department (PED) with incomplete or inappropriate instructions following a concussion. Our objective was to evaluate the effectiveness of a simple intervention in improving discharge instruction disbursement and completeness following PED diagnosis of concussion.
Methods:
A pre/post intervention study of 935 patients (375 preintervention and 560 postintervention) ages 5-19, diagnosed with a concussion and discharged from the PED between July 2016 and November 2019, was performed at a single United States pediatric tertiary-care center. Dedicated provider education sessions were held, and a consensus guideline-based set of discharge instructions were implemented in the electronic health record. Primary outcomes included the presence of return-to-play (RTP) instructions, return-to-learn (RTL) instructions, follow-up recommendations, and "complete" discharge (ie, all 3 components present). Statistical process control charts were generated and tested for special cause variation.
Results:
More patients received instructions for RTP (87% versus 59%) and RTL (60% versus 3%), and a complete discharge was more frequent (45% versus 2%), following the conclusion of the intervention. Only the improvement in RTP instructions was completely sustained into the following academic year, whereas RTL and complete discharge rates declined to 27% and 20%, respectively.
Conclusions:
A simple, low-cost intervention such as peer-to-peer education and consensus guideline-based discharge instruction templates can significantly improve discharge readiness after pediatric concussion. Further work is needed to maintain progress and continue improvements, at our large academic trauma center.
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