Picot question examples emergency nursing

Do Follow-up Phone Calls Post Discharge Impact ED Patients

Adult patients’ understanding of discharge instructions is crucial in all hospital settings and departments, but particularly in emergency department (ED) visits. Misunderstanding of these instructions can lead to adverse patient outcomes, including readmittances to the ED for the same underlying condition. Research has estimated that 22% of patients discharged from the ED return to the ED within 30-days (Rising et al., 2014). While readmissions are a major concern, other patient outcomes, such as patient satisfaction, patient compliance with post visit treatments, health literacy, and healthcare costs may also be impacted (JHU, 2014). Recent studies have demonstrated the need for greater comprehension of ED discharge instructions, reporting that 66% of patients had a “major deficit” in comprehension of their discharge instructions (Engel et al., 2012). Additionally, and potentially even more devastating, the majority of ED patients are unable to perceive that they do not understand these instructions (Engel et al., 2009) and are therefore less likely to seek additional support as needed. It should be noted that while patients often report that ED physicians spent adequate time with them prior to discharge, most patients did not fully understand all of these instructions including information about medications, signs of improvement, signs of worsening, and if and when to return to the ED (Engel et al., 2012; Gignon, Ammirati, Mercier, & Detave, 2014). Clearly research should be conducted to understand ways to positively impact comprehensive of discharge instructions, reduce ED readmissions, and ultimately improve patient care and reduce costs.

PICO(T) Question

The following PICO(T) question was developed to perform an evidence review on best practices surrounding adult patient discharge instructions and follow-up post discharge from an emergency department. PICO(T): Do follow-up phone calls by nursing staff or a case manager in addition to standard written discharge instructions, compared to standard practice (i.e., written discharge instructions with no follow-up phone calls), lead to better comprehension of discharge instructions, patient satisfaction, and ultimately fewer return visits within 30-days post discharge for adult emergency department patients?

· Population (P): adult patients discharged from the emergency room

· Intervention (I): follow-up phone calls from nursing staff, in addition to standard written discharge instructions

· Comparison (C): standard practice – written discharge instructions with no follow-up phone calls

· Outcome(s) (O): better comprehension of discharge instructions, patient satisfaction, and ultimately fewer return visits

· Time (T): within 30-days post discharge.

Description of Search

For this evidence review, both the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and PubMed databases were used to find literature surrounding the PICO(T) question. Specifically, the following search terms were used within both databases: “emergency” AND (“follow up” or “discharge”) AND (“telephone” or “phone call”). Results of both searches were limited to the last five years (2012-2017) and for adult human populations only (to exclude pediatric studies); the CINAHL search was further restricted to peer reviewed articles only. Based on this search criteria, CINAHL yielded a total of 94 articles and PubMed yielded a total of 306 articles. In addition to the database searches, two additional articles were identified through background research on this topic and included in this review, as they were relevant to the PICO(T) question.