Instrucciones de Alta por Video: Effectiveness of Video Discharge Instructions for Spanish-Speaking Caregivers in the Pediatric Emergency Department.

INTRODUCTION: Although evidence supports the addition of video discharge instructions to improve caregiver knowledge among English-speaking caregivers of children in the pediatric emergency department, there is no evidence about the effectiveness of videos for Spanish-speaking caregivers. The purpose of this study was to test whether Spanish video discharge instructions added to standard written and oral discharge instructions would result in improved knowledge and satisfaction among caregivers compared with written and oral instructions alone. METHODS: Spanish videos were created for fever, gastroenteritis, and bronchiolitis. A quasi-experimental, consecutive-sample, pre-post-test design was used with an audio computer-assisted survey platform to provide surveys in Spanish. The intervention group received written and oral instructions + video, whereas the comparison group received written and oral instructions alone. RESULTS: Data were collected from 150 caregivers. Caregivers who were given written and oral instructions + video showed significant knowledge improvement regarding their child's diagnosis and treatment (+19.3% and +23.6%, respectively, among standard participants; P < 0.001). Moreover, videos did not significantly improve caregivers' knowledge regarding illness duration and when to seek further care. Regardless of the discharge instruction format, no significant difference was observed in the helpfulness of the instructions (-1%; pre vs post, 84% vs 80%; χ2 = 0.35; P = 0.58). DISCUSSION: Study results demonstrate that when tailored to reflect diagnosis-specific education, video discharge instructions can improve Spanish-speaking caregiver knowledge about discharge education compared with written and oral instructions alone. Videos can be integrated to standardize the ED discharge process as an adjunct to nurse-provided written and oral instructions with an interpreter for Spanish-speaking families.

Evidence-Based Practice: Video-Discharge Instructions in the Pediatric Emergency Department.

PROBLEM: While a high quality discharge from a Pediatric Emergency Department helps caregivers feel informed and prepared to care for their sick child at home, poor adherence to discharge instructions leads to unnecessary return visits, negative health outcomes, and decreased patient satisfaction. Nurses at the Inova Loudoun Pediatric ED utilized the Johns Hopkins Model of Evidence Based Practice to answer the following question: Among caregivers who have children discharged from the ED, does the addition of video discharge instructions (VDI) to standard written/verbal discharge instructions (SDI) result in improved knowledge about the child's diagnosis, treatment, illness duration, and when to seek further medical care? METHODS: A multidisciplinary team reviewed available evidence and created VDI for three common pediatric diagnoses: gastroenteritis, bronchiolitis, and fever. Knowledge assessments were collected before and after delivery of discharge instructions to caregivers for both the SDI and VDI groups. RESULTS: Analysis found that the VDI group achieved significantly higher scores on the post test survey (P < .001) than the SDI group, particularly regarding treatment and when to seek further medical care. After integrating the best evidence with clinical expertise and an effective VDI intervention, the team incorporated VDI into the discharge process. IMPLICATIONS FOR PRACTICE: VDI offer nurses an efficient, standardized method of providing enhanced discharge instructions in the ED. Future projects will examine whether VDI are effective for additional diagnoses and among caregivers for whom English is not the primary language.