Effectiveness of teach-back in the emergency department

ISRCTN ISRCTN90792228
DOI https://doi.org/10.1186/ISRCTN90792228
Submission date
27/05/2020
Registration date
05/06/2020
Last edited
04/03/2022
Recruitment status
No longer recruiting
Overall study status
Completed
Condition category
Other
Prospectively registered
Protocol
Statistical analysis plan
Results
Individual participant data

Plain English summary of protocol

Background and study aims:
Providing patients with adequate discharge instructions is an important task of healthcare professionals to ensure a safe discharge from hospital to home. If patients are not able to understand the information given to them on leaving the hospital they may risk becoming unwell and returning to the Emergency Department (ED). Multiple revisits to the ED by patients can put increased strains and costs on health services.

With the 'teach-back' method patients or proxies (such as caregivers), repeat back what they understand so that professionals can confirm that the patient has understood the information given and can correct any misunderstandings.

This study aims to test if using the teach-back method will reduce ED revisits, and if it increases patient knowledge retention of discharge instructions, improves self-management at home, and increases satisfaction with the provision of discharge instructions.

Who can participate?
All patients discharged from the ED to their home/residence (including assisted living facilities such as a senior home or an outpatient rehabilitation center)

What does the study involve?
The study involves the collection of data from patients discharged from the ED for four months before the introduction of the use of the teach-back method by healthcare staff. This will be compared to data collected over four months of the method being used. The investigators will look at how often patients have to return to the ED after they are discharged. Older adults (aged ≥70 years) who participate in the study will be invited to answer some further questions via telephone within 72 hours after ED discharge to collect information on how well they can recall instructions and self-manage at home, and how satisfied they were with the discharge instructions.

What are the possible benefits and risks of participating?
Possible benefits for the participants, particularly those receiving teach-back, are a better recall/comprehension of ED discharge instructions, a higher level of self-management post-discharge, and a reduced risk for an unplanned ED-revisit.

Where is the study run from?
Radboud University Medical Center Nijmegen (Netherlands)

When is the study starting and how long is it expected to run for?
March 2019 to December 2019

Who is funding the study?
This study was funded by the 'Affordable Better' (in Dutch: 'Betaalbaar Beter') quality improvement program of the Radboud University Medical Center (Netherlands) and the Dutch health insurer VGZ (Netherlands).

Who is the main contact?
Dr Gijs Hesselink
gijs.hesselink@radboudumc.nl

Contact information

Dr Gijs Hesselink
Public

Geert Grooteplein Zuid 22
Nijmegen
6525 GA
Netherlands

ORCiD logoORCID ID 0000-0003-2532-0724
Phone +31 243666264
Email gijs.hesselink@radboudumc.nl

Study information

Study designSingle-center, single-arm, pre-post pilot interventional study
Primary study designInterventional
Secondary study designNon randomised study
Study setting(s)Hospital
Study typePrevention
Participant information sheet Not available in web format. Available in Dutch language upon request.
Scientific titlePre-post evaluation of the effects of teach-back of discharge instructions for patients in the ED on ED-revisits and patient-related outcomes
Study objectivesTeach-back of discharge instructions for patients in the ED might reduce ED revisits, and improve patient knowledge retention of discharge instructions, self-management at home and satisfaction with the provision of discharge instructions.
Ethics approval(s)Approved 11/02/2019, the local medical ethical commission of the Radboud University Nijmegen Medical Centre (CMO region Arnhem-Nijmegen (Routenr 629), p/a Radboudumc, house post 628, P.O. box 9101,
6500 HB Nijmegen, The Netherlands; +31 24 361 3154; commissiemensgebondenonderzoek@radboudumc.nl), ref: 2019-5166
Health condition(s) or problem(s) studiedEmergency Department (ED) visits
InterventionApplication of the teach-back method by Emergency Department (ED) professionals during the discharge conversation with patients or proxies (such as caregivers) in the ED.

Teach-back is a method whereby patients or proxies are asked to repeat back, in their own words or in demonstrations, the instructions that professionals provided them, so that comprehension of instructions can be confirmed, misunderstandings can be corrected and additional information can be provided if needed. The intervention lasts approximately 2-5 mins per patient. For a group of older participants aged over 75, there will be follow up via a structured telephone interview within 72 hours after ED discharge.
Intervention typeBehavioural
Primary outcome measureEmergency Department (ED) revisits within 7 days and within 8 to 30 days post-index visit assessed from the electronic medical record at 7 and 30 days
Secondary outcome measures1. Older patient's knowledge retention of discharge instructions across five information domains assessed by comparing the written and observed ED discharge instructions at discharge to patient responses in a structured telephone interview within 72 h after ED discharge
2. Older patient's self-reported self-management of patients at home assessed by a structured telephone interview within 72 h after ED discharge
3. Older patient satisfaction with discharge instructions provided by professionals in the ED assessed by a structured telephone interview within 72 h after ED discharge
Overall study start date18/12/2018
Completion date01/12/2019

Eligibility

Participant type(s)Patient
Age groupMixed
SexBoth
Target number of participants600 (including a minimum of 120 patients aged 70 years and older)
Total final enrolment648
Key inclusion criteriaDischarged from the Emergency Department (ED) to home (home including outpatient assisted living facilities such as a senior home or a rehabilitation center)
Key exclusion criteria1. Unable to speak the Dutch language
2. Discharged to another medical facility or ward
3. Severe mental/cognitive impairment (e.g. advanced dementia) without being accompanied by a caregiver at the ED
Date of first enrolment01/03/2019
Date of final enrolment31/10/2019

Locations

Countries of recruitment

  • Netherlands

Study participating centre

Radboud University Medical Center Nijmegen
Emergency Department
Geert Grooteplein Zuid 22
Nijmegen
6525 GA
Netherlands

Sponsor information

Radboud University Nijmegen Medical Centre
Hospital/treatment centre

Geert Grooteplein Zuid 22
Nijmegen
6525 GA
Netherlands

Phone +31 243666264
Email stafsecretariaat@seh.umcn.nl
Website https://www.radboudumc.nl/EN/Pages/default.aspx
ROR logo "ROR" https://ror.org/05wg1m734

Funders

Funder type

Hospital/treatment centre

Radboud Universitair Medisch Centrum
Private sector organisation / Universities (academic only)
Alternative name(s)
Radboudumc, Radboud University Medical Center, Radboud University Nijmegen Medical Center, RUNMC
Location
Netherlands
VGZ

No information available

Results and Publications

Intention to publish date01/10/2020
Individual participant data (IPD) Intention to shareYes
IPD sharing plan summaryAvailable on request
Publication and dissemination planWe intend to publish the findings of this pilot study in an academic journal in 2020.
IPD sharing planThe original quantitative SPSS datasets generated during and/or analysed during the current study are available upon reasonable request from Gijs Hesselink (gijs.hesselink@radboudumc.nl). Datasets will contain individual de-identified data of participants who gave written consent.

Study outputs

Output type Details Date created Date added Peer reviewed? Patient-facing?
Results article 17/06/2021 04/03/2022 Yes No

Editorial Notes

04/03/2022: Publication reference and total final enrolment added.
05/06/2020: The following changes have been made:
1. The intervention type has been changed from "Other" to "Behavioural".
2. The overall trial end date has been changed from 02/11/2019 to 01/12/2019 and the plain English summary has been updated to reflect this change.
03/06/2020: Trial’s existence confirmed by Radboud University Nijmegen Medical Centre.