Speak fast, use jargon, and don't repeat yourself: a randomized trial assessing the effectiveness of online videos to supplement emergency department discharge instructions

Clare L Atzema; Peter C Austin; Libo Wu; Michael Brzozowski; Michael J Feldman; Michael McDonnell; Laurie Mazurik

doi:10.1371/journal.pone.0077057

Speak fast, use jargon, and don't repeat yourself: a randomized trial assessing the effectiveness of online videos to supplement emergency department discharge instructions

PLoS One. 2013 Nov 11;8(11):e77057. doi: 10.1371/journal.pone.0077057. eCollection 2013.

Authors

Clare L Atzema¹, Peter C Austin, Libo Wu, Michael Brzozowski, Michael J Feldman, Michael McDonnell, Laurie Mazurik

Affiliation

¹ The Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada ; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada ; The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.

Abstract

Background: Emergency department discharge instructions are variably understood by patients, and in the setting of emergency department crowding, innovations are needed to counteract shortened interaction times with the physician. We evaluated the effect of viewing an online video of diagnosis-specific discharge instructions on patient comprehension and recall of instructions.

Methods: In this prospective, single-center, randomized controlled trial conducted between November 2011 and January 2012, we randomized emergency department patients who were discharged with one of 38 diagnoses to either view (after they left the emergency department) a vetted online video of diagnosis-specific discharge instructions, or to usual care. Patients were subsequently contacted by telephone and asked three standardized questions about their discharge instructions; one point was awarded for each correct answer. Using an intention-to-treat analysis, differences between groups were assessed using univariate testing, and with logistic regression that accounted for clustering on managing physician. A secondary outcome measure was patient satisfaction with the videos, on a 10-point scale.

Results: Among 133 patients enrolled, mean age was 46.1 (s.d.D. 21.5) and 55% were female. Patients in the video group had 19% higher mean scores (2.5, s.d. 0.7) than patients in the control group (2.1, s.d. 0.8) (p=0.002). After adjustment for patient age, sex, first language, triage acuity score, and clustering, the odds of achieving a fully correct score (3 out of 3) were 3.5 (95% CI, 1.7 to 7.2) times higher in the video group, compared to the control group. Among those who viewed the videos, median rating of the videos was 10 (IQR 8 to 10).

Conclusions: In this single-center trial, patients who viewed an online video of their discharge instructions scored higher on their understanding of key concepts around their diagnosis and subsequent care. Those who viewed the videos found them to be a helpful addition to standard care.

Trial registration: ClinicalTrials.gov NCT01361932 http://clinicaltrials.gov/ct2/show/NCT01361932?term=nct01361932&rank=1.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Emergency Service, Hospital*
Female
Humans
Internet*
Male
Patient Discharge*
Patient Satisfaction*
Video Recording*

Associated data

ClinicalTrials.gov/NCT01361932

Grants and funding

This project was supported by a grant from the Academic Physician’s Fund (AFP). Dr. Atzema is supported by the Practice Plan of the Department of Emergency Services at Sunnybrook Health Sciences Centre, the Department of Medicine, University of Toronto, and the Sunnybrook Research Institute. Dr. Austin is supported by a Career Investigator award from the Heart and Stroke Foundation. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.