Do parents value drowning prevention information at discharge from the emergency department?

Do Parents of Discharged Pediatric Emergency Department Patients Read Discharge Instructions?

OBJECTIVES

The percentage of discharged emergency department (ED) patients who read discharge instructions (DCIs) is unknown. In this study of parents of pediatric ED patients, we attempt to quantify the DCI readership rate and identify variables associated with readership. We hypothesized that few families would read their child's DCIs.

METHODS

We conducted a prospective, randomized study of parents of pediatric patients who were discharged home from the ED. We randomized participants to receive a study invitation as either the second or the second to last page of their DCIs. We incentivized study participation with a $10 gift card and then used the invitation response rate as a proxy for DCI readership. We utilized logistic regression to identify predictor variables showing significant association with readership.

RESULTS

One thousand patients were randomized; 963 were included in the final analysis. Eighty-four subjects, 8.8% (95% confidence interval, 7.0%-10.7%), responded to investigators. In the final regression model, private insurance (adjusted odds ratio, 1.76; P = 0.036), placement of the study invitation early within DCIs (adjusted odds ratio, 1.93; P = 0.011), and laceration diagnosis (adjusted odds ratio, 2.97; P = 0.012) predicted readership, whereas parents of Hispanic children were less likely to respond, even after adjustment for language spoken (adjusted odds ratio, 0.57; P = 0.028).

CONCLUSIONS

A minority of parents of patients discharged from the pediatric ED appear to read through their child's DCIs, with Hispanic families and those without private insurance least likely to read. Future research can explore how best to reach these particularly vulnerable families.

Cell Phone and Computer Use Among Parents Visiting an Urban Pediatric Emergency Department

OBJECTIVES

The objectives of this study were to estimate the prevalence of cell phone and computer use among urban families bringing their children to an emergency department and to determine which technologies parents prefer to use to receive health information.

METHODS

We visited 2 pediatric emergency departments in Baltimore, Md, and Little Rock, Ark. A convenience sample of parents of children 8 years old or younger completed a self-administered survey in the waiting area.

RESULTS

Two hundred thirty-eight surveys were completed. Respondents were primarily female (83%), less than 35 years old (74%), and had at least a high school diploma or General Educational Development (94%). Forty-three percent were employed full time. A majority (95%) of respondents reported owning a cell phone, with most (88%) owning a smartphone and 96% reported having some internet access. Of cell phone owners, 91% reported daily text messaging activity. Over half (63%) of respondents reported having computer internet access at home; 31% reported having internet access at work. Patterns of behavior and preferences emerged for both cell phone and computer use. Respondents were more likely to check their email (75% vs 50%, P < 0.0001) and access the internet (78% vs 67%, P = 0.002) with a smartphone rather than their computer.

CONCLUSIONS

Both cell phones and computers are prevalent and used among urban families seen in pediatric emergency departments, offering new ways to deliver health information to these often underserved populations. Providers aiming to deliver health information should consider smartphone applications, text message-based programs, and email to communicate with their patients.

Unintentional, non-fatal drowning of children: US trends and racial/ethnic disparities

OBJECTIVE

The current study aimed to better understand trends and risk factors associated with non-fatal drowning of infants and children in the USA using two large, national databases.

METHODS

A secondary data analysis was conducted using the National Inpatient Sample and the Nationwide Emergency Department Sample databases. The analytic sample (n=19,403) included children <21 years of age who had a diagnosis code for near-drowning/non-fatal drowning. Descriptive, χ(2) and analysis of variance techniques were applied, and incidence rates were calculated per 100,000 population.

RESULTS

Non-fatal drowning incidence has remained relatively stable from 2006 to 2011. In general, the highest rates of non-fatal drowning occurred in swimming pools and in children from racial/ethnic minorities. However, when compared with non-Hispanic Caucasian children, children from racial/ethnic minorities were more likely to drown in natural waterways than in swimming pools. Despite the overall lower rate of non-fatal drowning among non-Hispanic Caucasian children, the highest rate of all non-fatal drowning was for non-Hispanic Caucasian children aged 0-4 years in swimming pools. Children who were admitted to inpatient facilities were younger, male and came from families with lower incomes.

CONCLUSIONS

Data from two large US national databases show lack of progress in preventing and reducing non-fatal drowning admissions from 2006 to 2011. Discrepancies are seen in the location of drowning events and demographic characteristics. New policies and interventions are needed, and tailoring approaches by age and race/ethnicity may improve their effectiveness.

Interventions associated with drowning prevention in children and adolescents: systematic literature review

INTRODUCTION

Drowning remains a leading cause of preventable death in children across the world. This systematic review identifies and critically analyses studies of interventions designed to reduce fatal and non-fatal drowning events among children and adolescents or reduce the injury severity incurred by such incidents.

METHODS

A systematic search was undertaken on literature published between 1980 and 2010 relating to interventions around fatal and non-fatal drowning prevention in children and adolescents 0-19 years of age. Search methods and protocols developed and used by the WHO Global Burden of Disease Injury Expert Group were applied.

RESULTS

Seven studies fulfilled the inclusion criteria. Interventions were categorised into three themes of Education, Swimming Lessons and Water Safety, and Pool Fencing. All are possible effective strategies to prevent children from drowning, particularly young children aged 2-4 years, but very little evidence exists for interventions to reduce drowning in older children and adolescents. There were methodological limitations associated with all studies, so results need to be interpreted in the context of these.

CONCLUSIONS

Relatively few studies employ rigorous methods and high levels of evidence to assess the impact of interventions designed to reduce drowning. Studies are also limited by lack of consistency in measured outcomes and drowning terminology. Further work is required to establish efficacy of interventions for older children and adolescents. There is a need for rigorous, well-designed studies that use consistent terminology to demonstrate effective prevention solutions.

Barriers to life jacket use among adult recreational boaters

OBJECTIVE

To identify barriers to life jacket use.

DESIGN

Cross-sectional survey.

SETTING

Nine public boat ramps in western Washington State, USA, August-November, 2008.

PARTICIPANTS

675 adult boaters (>18 years) on motor boats <26 feet long.

MAIN OUTCOME

Low or no life jacket use (0-50% of time) versus high life jacket use (51-100% of time).

RESULTS

Low/no life jacket use (0-50% of time) was associated with longer boat length (per foot, risk ratio [RR] 1.03, 95% CI 1.02 to 1.05), alcohol use (RR 1.11, 95% CI 1.01 to 1.20), perception of life jackets as 'uncomfortable' (RR 1.29, 95% CI 1.09 to 1.52), perceived greater level of swimming ability (RR 1.25, 95% CI 1.03 to 1.53 for 'expert swimmer') and possibly with lack of confidence that a life jacket may save one from drowning (RR 1.13, 95% CI 0.96 to 1.32). Low life jacket use was less likely when an inflatable life jacket was the primary life jacket used by a subject (RR 0.77, 95% CI 0.63 to 0.94), a child was onboard (RR 0.88, 95% CI 0.79 to 0.99) or if the respondent had taken a boating safety class (RR 0.94, 95% CI 0.87 to 1.01).

CONCLUSIONS

Life jacket use may increase with more comfortable devices, such as inflatable life jackets, and with increased awareness of their efficacy in preventing drowning. Boater education classes may be associated with increased life jacket use among adults.

Injury prevention: opportunities in the emergency department

Because injury is the leading cause of morbidity and mortality in young patients, emergency departments have a significant opportunity to provide injury-prevention interventions at a teachable moment. The emergency department has the ability to survey injuries in the community, use the hospital setting to screen patients, provide products, offer resources to assist families within this setting to change their risky behaviors, and connect families to community resources. With a thoughtful, collaborative approach, emergency departments are an excellent setting within which to promote injury prevention among patients and families.

Emergency physicians' knowledge and provision of child passenger safety information

OBJECTIVES

While physicians provide discharge instructions to patients and families following emergency department (ED) visits, injury prevention information may not be routinely included in these instructions. This study assessed emergency physicians' knowledge and provision of child passenger safety (CPS) information to patients following motor vehicle crashes (MVCs).

METHODS

This study was both a survey of emergency physician knowledge and provision of CPS information and an examination of frequency of CPS information in discharge instructions at a single institution. Members of the American Academy of Pediatrics (AAP) Section on Emergency Medicine were invited to participate in the survey. Respondents were asked about their provision of CPS information to patients and knowledge of national AAP CPS recommendations. The institutional ED medical record chart review assessed the frequency of written CPS information for patients of MVC-related visits who were discharged home.

RESULTS

There were 317 survey respondents from 1,024 eligible physicians, of whom 43 began but did not complete the survey. The data analyzed are from the 274 who completed the survey. While 85% (95% confidence interval [CI] = 81% to 89%) of physicians believed that CPS information should be included in discharge instructions, only 36% (95% CI = 31% to 42%) correctly answered all knowledge questions. Of the 51 self-identified division/department chiefs, 15 (29.4%; 95% CI = 16.9% to 41.9%) reported that their EDs routinely provide CPS information in discharge instructions for pediatric passengers in MVCs. For the medical record review, of the 152 randomly selected MVC visits, 13 (8.6%; 95% CI = 4.1% to 13.0%) had documented CPS information in the discharge instructions. Patients with documented CPS information were younger, but there were no significant differences in race, sex, or maximum abbreviated injury scale score between patients with versus without CPS information.

CONCLUSIONS

While emergency physicians value the use of CPS information in discharge instructions following MVCs, they do not have adequate knowledge of, nor do they regularly disseminate, this information.

Use of a safety resource center in a pediatric emergency department

OBJECTIVE

To describe the use of a safety resource center (SRC) within a pediatric emergency department (ED) about injury prevention (IP) counseling, sales, costs, and parental responses to the services.

METHODS

The SRC was established in June 2005 in the waiting area of an urban pediatric ED caring for approximately 96,000 patients annually. Safety resource center staff sells products of proven efficacy (eg, car seats, smoke alarms, and bike helmets) and offers safety education materials to patients and families. Activities including sales, educational content provided, types of inquiries from families, and overall satisfaction with the service were logged into a Microsoft Access database. Follow-up phone calls are made to all families 3 weeks after they purchase a product.

RESULTS

Between June 20, 2005 and July 1, 2007, the SRC served approximately 13,000 families. Seven hundred eighty-six families purchased 816 products, generating $14,859. An additional 473 products were given away, totaling 1289 product items provided to families. The most commonly purchased items were car safety seats and bicycle helmets. Roughly 7000 IP-related brochures were distributed to ED families, and 120 car seats were fitted. Of the 786 families who made a purchase, 383 (49%) were reached for follow-up. Ninety-seven percent reported to still be using the purchased product, and 28% made a different change in the home to practice safer behaviors. Ninety-five percent were grateful that the SRC was located in the ED.

CONCLUSIONS

The SRC can provide IP product, encourage families to practice safer behaviors, and is well-received within a large, urban pediatric ED.

Injury prevention in the emergency department: a caregiver's perspective

BACKGROUND

Emergency medicine physicians and their staff care for high-risk injured patients, making the emergency department (ED) an appropriate place to discuss injury prevention (IP).

OBJECTIVE

To determine family receptiveness to and short-term effectiveness of IP information delivery during an ED visit.

METHODS

A cross-sectional survey was conducted in an urban pediatric ED. Caregivers of children younger than 15 years, with any chief complaint, were approached to participate. The survey consisted of caregiver's background, IP information received by their primary care pediatrician, and their wishes for receiving IP information in the ED. At survey completion, participants were given an age-appropriate IP handout. Follow-up phone surveys were made at 2 weeks to determine caregiver satisfaction and any self-reported IP changes made.

RESULTS

Two hundred fifty-one caregivers were approached. Two hundred forty-six (98%) were interested in receiving IP information in the ED, and 217 (86%) consented to participate. Ninety-three percent felt that the ED should provide IP information; 83% believed it should be offered even if it prolonged their ED visit. There was no significant difference among participants with regard to who should provide the information or how it should be provided. One hundred thirty (60%) of 217 completed the follow-up survey. Ninety-seven percent felt that the IP information was useful, and 63% kept the handout in a retrievable place. Twenty-eight percent of caregivers who completed the follow-up survey reported to change their safety behavior as a result of their ED encounter.

CONCLUSIONS

Many families surveyed in an urban pediatric ED wished for IP information in the ED setting. A simple IP intervention in an ED setting may encourage families to practice safer behaviors for their children.

Survey of current injury prevention practices by registered nurses in the emergency department

INTRODUCTION

It has been shown that a vast majority of injured patients who seek treatment in emergency departments are seen and released. The events resulting in the individuals seeking treatment may have been preventable and some of the time spent in an emergency department could be used for injury prevention (IP) education. This study sought to determine current IP practices of registered nurses working in an emergency department, to discover whether or not they believed IP was important, and to identify perceived obstacles for incorporating IP education into clinical practice.

METHODS

A convenience sample of 150 registered nurses working in the emergency departments of an adult level 1 trauma centre in Ontario, Canada was used. A descriptive survey composed of 10 questions was used. Data analysis was completed using SPSS Version 11.0.

RESULTS

Findings suggest current IP strategies are varied, and implemented inconsistently. Evidence indicates educating patients about IP is an important part of the emergency nurse role. However, time, education, and resources were recognized obstacles to implementation.

DISCUSSION

A better understanding of registered nurses' current IP practices will guide the development and implementation of a future adult focused injury prevention program for ED patients.

Management of pediatric penetrating oropharyngeal trauma

Penetrating oropharyngeal trauma (OPT) is common in young children. Complications are rare but can be severe and with delayed onset. Controversy exists about the evaluation and management of OPT, although most injuries in the stable child can be managed in the outpatient setting. Two pediatric OPT cases and a brief review of the literature are presented.

Health promotion and disease prevention in the emergency department

This article provides an overview of health promotion and disease and injury prevention concepts. It provides an emergency medicine perspective and reviews approaches that can be used in the emergency department. It discusses examples of innovative emergency medicine-based preventive activities including prevention in the prehospital setting. This article ends with a discussion of the importance of a system approach to prevention and suggests a role for a preventionist as a new member of the emergency medicine team.

An emergency department intervention to increase booster seat use for lower socioeconomic families

OBJECTIVES

To evaluate the effectiveness of booster seat education within an emergency department (ED) setting for families residing in lower socioeconomic neighborhoods.

METHODS

This was a prospective, randomized study of families with children aged 4 to 7 years and weighing 40 to 80 lb who presented to a pediatric ED without a booster seat and resided in lower socioeconomic communities. Subjects were randomly assigned to one of three groups: 1) received standard discharge instructions, 2) received five-minute booster seat training, and 3) received five-minute booster seat training and free booster seat with installation. Automobile restraint practices were obtained initially and by telephone at one month.

RESULTS

A total of 225 children were enrolled. Before randomization in the study, 79.6% of parents reported that their child was usually positioned in the car with a lap/shoulder belt and 13.3% with a lap belt alone. Some parents (16.4%) had never heard of a booster seat, and 44.9% believed a lap belt was sufficient restraint. A total of 147 parents (65.3%) were contacted for follow-up at one month. Only one parent (1.3%) in the control group and four parents (5.3%) in the education group purchased and used a booster seat after their ED visit, while 55 parents (98.2%) in the education and installation group reported using the booster seat; 42 (75.0%) of these parents reported using the seat 100% of the time.

CONCLUSIONS

Education in a pediatric ED did not convince parents to purchase and use booster seats; however, the combination of education with installation significantly increased booster seat use in this population.

Role of diagnosis-specific information sheets in parents' understanding of emergency department discharge instructions

OBJECTIVES

To investigate the contribution of diagnosis-specific information sheets at discharge from the emergency department on parental understanding of the discharge instructions.

METHODS

The study group consisted of a convenience sample of parents of children discharged home from the emergency department of an urban tertiary care pediatric facility (n=95). At discharge by the physician, all were given a disease-specific information sheet to accompany the physician's discharge instructions. Thereafter, the parents were asked to complete the same 13-item questionnaire used in our previous study, covering demographics, level of anxiety, and quality of physician's explanation, in addition to a description, in their own words, of their child's diagnosis and treatment instruction and an indication of their preferred auxiliary method of delivery of information. The findings were compared with the study group in the first phase study (n=287) who did not receive the disease-specific information sheet. The BMDP statistical package was used for the analysis.

RESULTS

No statistically significant differences between the two groups in age, sex, and education, level of anxiety before or after the emergency department visit, or time of day were observed. Full understanding of the diagnosis was noted in 73% of the parents who received the information sheet and 72% of the parents in our previous study who did not. Corresponding rates of understanding of the treatment instructions were 92% and 82%. On statistical analysis, the distribution of the diagnosis-specific information sheet significantly improved parental understanding of the treatment instructions (P=0.025), but not of the diagnosis (P=0.54).

CONCLUSIONS

Although overall parental understanding of emergency department discharge instructions is good, understanding of the treatment instructions can be further improved with the use of diagnosis-specific information sheets.

Review of the role of alcohol in drowning associated with recreational aquatic activity

OBJECTIVE AND DESIGN

To assess the role of alcohol in drowning associated with recreational aquatic activity by reviewing the English language literature published up to October 2003.

RESULTS

Alcohol is widely used in association with recreational aquatic activity in the United States, but there is minimal information regarding the extent of use elsewhere. A priori and anecdotal evidence suggests that alcohol is an important risk factor for drowning associated with recreational aquatic activity. Specific studies provide good evidence supporting this, but the extent of increased risk associated with alcohol use, and the attributable risk due to alcohol use, is not well characterised. Drowning appears to be the overwhelming cause of death associated with recreational aquatic activity with alcohol detected in the blood in 30%-70% of persons who drown while involved in this activity. The few relevant studies on degree of increased risk suggest persons with a blood alcohol level of 0.10 g/100 ml have about 10 times the risk of death associated with recreational boating compared with persons who have not been drinking, but that even small amounts of alcohol can increase this risk. The population attributable risk seems to be in the range of about 10%-30%.

CONCLUSIONS

Alcohol consumption significantly increases the likelihood of immersions resulting in drowning during aquatic activities. However, more information is required if appropriate prevention activities are to be planned, initiated, and evaluated. This includes better information on alcohol use, and attitudes to alcohol use, in association with recreational aquatic activity, and the nature and extent of increased risk associated with alcohol use. Evaluation of interventions is also needed.

Structure and function of the emergency department: matching emergency department choices to the emergency department mission

Emergency caregivers experience considerable new challenges to the provision of competent, compassionate care. The good news is there are ample new approaches and new technologies to meet those new challenges.ED leaders who understand the ED mission and the resources available today and who engage vigorously in the change process will turn that mission into immensely beneficial action.