{"showCoverPage":true,"bookCover":{"coverDescription":"

Learning Outcomes<\/strong><\/p>\n\n

Increase knowledge of discharge within the ED<\/em><\/p>\n\n

Increase confidence providing discharge within the ED<\/em><\/p>\n\n

Increase knowledge of benefits from utilizing a discharge handout within the ED<\/em><\/p>\n\n

<\/p>\n\n

Developed by: Kaley Lapierre, RN<\/p>\n","coverMedium":{"library":"H5P.Image 1.1","metadata":{"contentType":"Image","license":"U","title":"Untitled Image"},"params":{"contentName":"Image","decorative":false,"file":{"path":"images\/coverImage-61fbb68d2d1e4.jpg","mime":"image\/jpeg","width":760,"height":760}},"subContentId":"b3664694-be81-4308-a23c-3985a67d92aa"}},"chapters":[{"params":{"content":[{"content":{"params":{"text":"

Please complete this short survey before continuing into the module.<\/span><\/strong><\/span><\/p>\n"},"library":"H5P.AdvancedText 1.1","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"},"subContentId":"369f5d42-f3bb-42cb-87d1-c02bceaf99ba"},"useSeparator":"auto"},{"useSeparator":"auto","content":{"params":{"linkWidget":{"protocol":"https:\/\/","url":"www.cognitoforms.com\/UniversityOfOttawa3\/dischargeteachingintheemergencydepartmentpresurvey"},"title":"CLICK HERE for Discharge Teaching in the ED: Pre-Survey"},"library":"H5P.Link 1.3","metadata":{"contentType":"Link","license":"U"},"subContentId":"4959e427-2456-43b4-9f14-c6579fa7910d"}},{"content":{"params":{"contentName":"Image","file":{"path":"images\/file-620639eabf769.jpg","mime":"image\/jpeg","copyright":{"license":"U"},"width":485,"height":323,"originalImage":{"path":"images\/file-61ffdeefd6a0c.jpg","mime":"image\/jpeg","height":324,"width":486}}},"library":"H5P.Image 1.1","metadata":{"contentType":"Image","license":"U","title":"Untitled Image"},"subContentId":"a25ad330-3b92-4790-949e-0c47b18f74ce"},"useSeparator":"auto"}]},"library":"H5P.Column 1.16","subContentId":"6714a821-a7a9-40d1-b45b-b87012051f91","metadata":{"contentType":"Column","license":"U","title":"Pre-Survey"}},{"params":{"content":[{"content":{"params":{"contentName":"Image","file":{"path":"images\/file-61ffa8f72fd34.jpg","mime":"image\/jpeg","copyright":{"license":"U"},"width":720,"height":419}},"library":"H5P.Image 1.1","metadata":{"contentType":"Image","license":"U","title":"Untitled Image"},"subContentId":"1a254bbf-8a5c-4e94-85ac-24930c5b0ed1"},"useSeparator":"auto"},{"useSeparator":"auto","content":{"params":{"text":"

Benefits of Discharge Teaching <\/strong><\/h2>\n\n
Communication at discharge is an important part of high-quality ED care. Patients need structured content, presented verbally with written and visual cues to enhance recall.<\/span><\/p>\n\n
Discharge in the ED is an opportunity to synthesize, answers questions and coordinate care.<\/span><\/p>\n\n
High quality discharge has 3 components (Samuels-Kalow et al., 2012).<\/span><\/p>\n\n
\n\t
\n\t
Informs and educates patients on their diagnosis, prognosis, treatment plan, and expected course of illness<\/span><\/p>\n\t<\/li>\n\t
\n\t
Supports patients in receiving post-ED discharge care<\/span><\/p>\n\t<\/li>\n\t
\n\t
Coordinates ED care<\/span><\/p>\n\t<\/li>\n<\/ol>\n"},"library":"H5P.AdvancedText 1.1","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"},"subContentId":"c8665844-987b-41c4-92a2-f01290ffd2df"}}]},"library":"H5P.Column 1.16","subContentId":"250c274c-0174-4c12-bbcb-de891e86af4f","metadata":{"contentType":"Column","license":"U","title":"Discharge in the ED: Benefits"}},{"params":{"content":[{"content":{"params":{"contentName":"Image","file":{"path":"images\/file-620643a2967c1.jpg","mime":"image\/jpeg","copyright":{"license":"U"},"width":960,"height":379},"alt":"Break through"},"library":"H5P.Image 1.1","metadata":{"contentType":"Image","license":"U","title":"Untitled Image"},"subContentId":"aaf32541-f667-49a0-8e52-5a73e0eaf1c1"},"useSeparator":"auto"},{"useSeparator":"auto","content":{"params":{"text":"
Barriers to Effective Discharge <\/h2>\n\n
When discharge planning in the ED is not routinely performed by the nursing staff it leads to health risks to the patients, lost trust in the healthcare system, and unsatisfied patients (Marty et al., 2013).<\/span><\/p>\n\n
However, discharge in the ED is challenging due to lack of resources, time, and competing demands, which often leads to discharge failure when not seen as a priority amongst competing demands of the provider (Marty et al., 2013).<\/span><\/p>\n\n
Discharge failure can lead to:<\/span><\/p>\n\n
\n\t
\n\t
Increased p<\/span>atient complaints <\/span><\/p>\n\t<\/li>\n\t
\n\t
Frequent calls to the ED charge nurse <\/span><\/p>\n\t<\/li>\n\t
\n\t
Repeat visits within 72 hours<\/span><\/p>\n\t<\/li>\n\t
\n\t
Missed follow up appointments<\/span><\/p>\n\t<\/li>\n\t
\n\t
Mismanagement of symptoms <\/span><\/p>\n\t<\/li>\n<\/ul>\n\n
Barriers to high quality discharge that the nurse should be aware of include:<\/span><\/p>\n\n
\n\t
\n\t
Low income\/homelessness<\/span><\/p>\n\t<\/li>\n\t
\n\t
No primary care provider <\/span><\/p>\n\t<\/li>\n\t
\n\t
Poor comprehension\/health literacy<\/span><\/p>\n\t<\/li>\n\t
\n\t
Complex medical history <\/span><\/p>\n\t<\/li>\n<\/ul>\n"},"library":"H5P.AdvancedText 1.1","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"},"subContentId":"c088d4e4-e99d-4a3b-96c3-ee29189526c9"}}]},"library":"H5P.Column 1.16","subContentId":"333e464a-63c6-43f5-9a5a-91b73ccce2e6","metadata":{"contentType":"Column","license":"U","title":"Discharge in the ED: Barriers"}},{"params":{"content":[{"useSeparator":"auto","content":{"params":{"contentName":"Image","file":{"path":"images\/file-61ffb52bc603a.jpg","mime":"image\/jpeg","copyright":{"license":"U"},"width":1299,"height":729}},"library":"H5P.Image 1.1","metadata":{"contentType":"Image","license":"U","title":"Untitled Image"},"subContentId":"939049e8-f62b-4ac7-b63e-797613850ded"}},{"content":{"params":{"text":"
Case Study<\/h2>\n\n
A 25-year-old developmentally delayed female was involved in a head on motor vehicle collision at approximately 65km\/hr. She was in the passenger's seat, belted, windshield was shattered, airbags deployed. The patient sustained a head injury, did not lose consciousness and was GCS 15 on arrival by EMS. Vital signs were stable, no resuscitation was required. Patient sustained a large wound to her left upper arm along with a left radius fracture. <\/p>\n\n
Upon arrival to the ED patient had a CT head which had no abnormal findings. A closed reduction of her fractured arm was performed and casted. The patient's wound was cleansed, sutured and dressings applied. <\/p>\n\n
Following a 6-hour observation period the ED physician discharged her home. <\/p>\n"},"library":"H5P.AdvancedText 1.1","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"},"subContentId":"5f080893-73bd-48c5-a2d9-806b5590b539"},"useSeparator":"auto"}]},"library":"H5P.Column 1.16","subContentId":"0fd27af0-28bb-48ce-ad2a-0e580764fbd7","metadata":{"contentType":"Column","license":"U","title":"Case Study"}},{"params":{"content":[{"content":{"params":{"text":"
Discharge Teaching<\/h2>\n\n
The ED nurse provided discharge teaching to the patient and her mother without the use of a handout based on her own experience and expertise as follows:<\/p>\n\n
Nurse: Hi, I'm happy you're starting to feel better; the doctor says you're well enough to go home now. I'm here to talk to you about discharge, is now a good time?<\/span><\/p>\n\n
Patient: Yes, I'm ready to go home.<\/span><\/p>\n\n
Nurse: Excellent, as the doctor mentioned you sustained a very deep wound to your arm as well as a fracture. We're going to send a referral to Home Care to come and assist you with dressing changes as well as Occupational Therapy to help you manage at home. They will call you in 6-8 weeks. <\/span><\/p>\n\n
Mom: The doctor mentioned something about pain medication.<\/span> <\/p>\n\n
Nurse: Yes, she prescribed Dilaudid to take every 4 hours as needed, this medication is a strong pain reliever but can cause constipation in some people.<\/span><\/p>\n\n
Patient: When do I get my stitches out?<\/span><\/p>\n\n
Nurse: Great question; we already made you an appointment 6 weeks from now to return to our clinic in the next building over to have them removed. Here is a document that explains how to care for your sutures, the date and time of your appointment, as well as who to call if you can't make it and need to reschedule. Do you have any other questions?<\/span><\/p>\n\n
Patient: No, I don't think so.<\/span><\/p>\n\n
Mom: No, not right now, I'm still a little overwhelmed by today.<\/span><\/p>\n\n
Nurse: Okay great, go ahead and get dressed and I will come back in 5 minutes to show you the way out of the department. <\/span><\/p>\n"},"library":"H5P.AdvancedText 1.1","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"},"subContentId":"7ee785eb-6ab0-483f-947d-4164d60e043e"},"useSeparator":"auto"},{"content":{"params":{"media":{"disableImageZooming":false},"correct":"true","behaviour":{"enableRetry":true,"enableSolutionsButton":true,"enableCheckButton":true,"confirmCheckDialog":false,"confirmRetryDialog":false,"autoCheck":false},"l10n":{"trueText":"True","falseText":"False","score":"You got @score of @total points","checkAnswer":"Check","submitAnswer":"Submit","showSolutionButton":"Show solution","tryAgain":"Retry","wrongAnswerMessage":"Wrong answer","correctAnswerMessage":"Correct answer","scoreBarLabel":"You got :num out of :total points","a11yCheck":"Check the answers. The responses will be marked as correct, incorrect, or unanswered.","a11yShowSolution":"Show the solution. The task will be marked with its correct solution.","a11yRetry":"Retry the task. Reset all responses and start the task over again."},"confirmCheck":{"header":"Finish ?","body":"Are you sure you wish to finish ?","cancelLabel":"Cancel","confirmLabel":"Finish"},"confirmRetry":{"header":"Retry ?","body":"Are you sure you wish to retry ?","cancelLabel":"Cancel","confirmLabel":"Confirm"},"question":"
The above dishcarge could have been improved through the use of a standardized handout. <\/strong><\/h3>\n"},"library":"H5P.TrueFalse 1.8","metadata":{"contentType":"True\/False Question","license":"U","title":"True\/False"},"subContentId":"530ca859-ae07-4df6-8aaa-d3d3cd8ee932"},"useSeparator":"auto"}]},"library":"H5P.Column 1.16","subContentId":"0827c157-95a4-4c4e-b36d-97c49886db7b","metadata":{"contentType":"Column","license":"U","title":"Discharge Teaching"}},{"params":{"content":[{"useSeparator":"auto","content":{"params":{"text":"
Discharge Handout<\/h2>\n\n
Patients leaving the ED are frequently unable to recall important elements of the visit, utilizing a discharge tool can improve patient recall and help the nurse guide the discharge conversation (Hall et al., 2018).<\/p>\n\n
A discharge handout is a standardized, structured approach to informing and educating patients on their diagnosis, prognosis, treatment plan, and expected course of illness. <\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/p>\n\n
The below example of a discharge handout was created using the Patient Oriented Discharge Summary (PODS) discharge tool. It's implementation in Ontario hospitals has demonstrated improvement in patient-centred discharge processes linked to quality standards and health outcomes (Hahn-Goldberg et al., 2021)<\/p>\n"},"library":"H5P.AdvancedText 1.1","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"},"subContentId":"aa5ccd1e-f988-4450-84d8-4b74e6006908"}},{"content":{"params":{"contentName":"Image","file":{"path":"images\/file-62063cfce1bf7.png","mime":"image\/png","copyright":{"license":"U"},"width":795,"height":986},"alt":"Discharge Handout Page 1"},"library":"H5P.Image 1.1","metadata":{"contentType":"Image","license":"U","title":"Untitled Image"},"subContentId":"a67499cb-5da4-49a4-a8b7-d9ea6b8c94a9"},"useSeparator":"auto"},{"content":{"params":{"contentName":"Image","file":{"path":"images\/file-62063d253617d.png","mime":"image\/png","copyright":{"license":"U"},"width":791,"height":995},"alt":"Discharge Handout Page 2"},"library":"H5P.Image 1.1","metadata":{"contentType":"Image","license":"U","title":"Untitled Image"},"subContentId":"5a2ed741-bdf9-4ff8-98ed-9a71d6ae66f6"},"useSeparator":"auto"},{"content":{"params":{"text":"
Engaging in discharge conversations can be challenging in the ED especially if the patient and\/or their family member isn't happy with the physicians decisions to discharge. Below are two examples of how you could get the conversations started:<\/span><\/em><\/p>\n\n
<\/p>\n"},"library":"H5P.AdvancedText 1.1","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"},"subContentId":"d0b214db-0b12-4fe0-81ce-1f1edb05cb7c"},"useSeparator":"auto"},{"content":{"params":{"mode":"normal","description":"","dialogs":[{"tips":{},"text":"
How would you start the conversation for someone who is happy and ready for discharge?<\/p>\n\n
Turn the card for an example!<\/p>\n","image":{"path":"images\/image-62063fbd97073.jpg","mime":"image\/jpeg","copyright":{"license":"U"},"width":424,"height":1024},"imageAltText":"NURSE 1","answer":"
Hi, I'm so happy to hear you're starting to feel better and get to go home. I'm here to talk to you about discharge and answer any questions you may have...<\/p>\n"},{"tips":{},"text":"
How would you start the conversation for someone who is anxious and uncertain about discharge?<\/p>\n\n
Turn the card for an example!<\/p>\n","image":{"path":"images\/image-620640002f811.jpg","mime":"image\/jpeg","copyright":{"license":"U"},"width":236,"height":531},"imageAltText":"NURSE 2","answer":"
Hi, I'm so happy to hear you're starting to feel better and get to go home. I understand you're feeling a little nervous, that is completely normal, you've had a scary experience. I'm here to talk to you about discharge and answer any of your questions. Once we're done if you still think you're not ready I'd be happy to get the doctor and we can all talk together about your concerns.<\/p>\n"}],"behaviour":{"enableRetry":true,"disableBackwardsNavigation":false,"scaleTextNotCard":false,"randomCards":false,"maxProficiency":5,"quickProgression":false},"answer":"Turn","next":"Next","prev":"Previous","retry":"Retry","correctAnswer":"I got it right!","incorrectAnswer":"I got it wrong","round":"Round @round","cardsLeft":"Cards left: @number","nextRound":"Proceed to round @round","startOver":"Start over","showSummary":"Next","summary":"Summary","summaryCardsRight":"Cards you got right:","summaryCardsWrong":"Cards you got wrong:","summaryCardsNotShown":"Cards in pool not shown:","summaryOverallScore":"Overall Score","summaryCardsCompleted":"Cards you have completed learning:","summaryCompletedRounds":"Completed rounds:","summaryAllDone":"Well done! You got all @cards cards correct @max times in a row!","progressText":"Card @card of @total","cardFrontLabel":"Card front","cardBackLabel":"Card back","tipButtonLabel":"Show tip","audioNotSupported":"Your browser does not support this audio","confirmStartingOver":{"header":"Start over?","body":"All progress will be lost. Are you sure you want to start over?","cancelLabel":"Cancel","confirmLabel":"Start over"},"title":""},"library":"H5P.Dialogcards 1.9","metadata":{"contentType":"Dialog Cards","license":"U","title":"Untitled Dialog Cards"},"subContentId":"44284121-93c0-4e19-b417-1594bac27a1a"},"useSeparator":"auto"}]},"library":"H5P.Column 1.16","subContentId":"8c1bc286-1dd2-4dd3-829b-580e52432efc","metadata":{"contentType":"Column","license":"U","title":"Handout"}},{"params":{"content":[{"useSeparator":"auto","content":{"params":{"text":"
Improvement Opportunity <\/h2>\n\n
Through the use of a discharge tool the discharge provided to this patient could have been improved by aiding the nurse to ensure no components of discharge are missed. The below table outlines rationale for each area of discharge that should have been covered for this patient.<\/p>\n\n
<\/span>Green<\/span> = Covered Red<\/span> = Missed <\/p>\n"},"library":"H5P.AdvancedText 1.1","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"},"subContentId":"31da6d3a-997d-436f-9b11-ba184012aa17"}},{"content":{"params":{"text":"
\n\t\n\t\t\n\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t\n\t\t\t
Topic <\/strong><\/td>\n\t\t\t Rationale<\/strong><\/td>\n\t\t<\/tr>\n\t\t
\n\t\t\t
Discharge Diagnosis<\/strong><\/div>\n\n\t\t\t
Radial Fracture <\/span><\/div>\n\n\t\t\t
Laceration <\/span><\/div>\n\n\t\t\t
C<\/span>oncussion <\/span><\/div>\n\n\t\t\t
<\/div>\n\t\t\t<\/td>\n\t\t\t
\n\t\t\t
Included:<\/strong> The nurse discussed both the laceration and fracture providing the patient and her mom with suture care and follow-up information<\/div>\n\n\t\t\t
------------------------------------------------------------------------------------------------------<\/div>\n\n\t\t\t
Not Included:<\/strong> Patient's who experience concussions can have delayed symptom onset and require teaching on what is normal and can be treated at home, and when to return to the hospital for further assessment. <\/div>\n\t\t\t<\/td>\n\t\t<\/tr>\n\t\t
\n\t\t\t
When to Return to Hospital<\/strong><\/div>\n\n\t\t\t
Signs of infection <\/span><\/div>\n\n\t\t\t
Signs of compartment syndrome <\/span><\/div>\n\n\t\t\t
<\/div>\n\t\t\t<\/td>\n\t\t\t
\n\t\t\t
Included:<\/strong> The nurse did a great job providing teaching on what signs of infection to watch for, and when to return to hospital. This ultimately could save the patients life if she became septic. With a large wound on the L upper arm, close to the heart, a severe infection could put the patient's life in jeopardy quickly, she should be reassessed and started on antibiotics at the first sign of infection. <\/div>\n\n\t\t\t
-----------------------------------------------------------------------------------------------------<\/div>\n\n\t\t\t
Not Included<\/strong>: The nurse forgot to do teaching on compartment syndrome, which should be closely monitored for with any patient who has been casted to prevent loss of blood flow and risk of limb loss<\/div>\n\t\t\t<\/td>\n\t\t<\/tr>\n\t\t
\n\t\t\t
Medication Review<\/strong> <\/div>\n\n\t\t\t
Dilaudid <\/span><\/div>\n\n\t\t\t
Non-prescribed <\/span>Medications<\/span><\/div>\n\t\t\t<\/td>\n\t\t\t
\n\t\t\t
Included: <\/strong>This helps the patient feel more confident in managing new medication at home<\/div>\n\n\t\t\t
-----------------------------------------------------------------------------------------------------<\/div>\n\n\t\t\t
Not Included:<\/strong> The importance of regular Tylenol\/Advil for pain management and to reduce swelling. Over the counter medications that could be used to counter the constipating effects of Dialudid such as Colace or Restoralax. It's always a good idea to refer the patient to their local pharmacist for any further medication related questions. <\/div>\n\t\t\t<\/td>\n\t\t<\/tr>\n\t\t
\n\t\t\t
Changes to Routine<\/strong><\/div>\n\n\t\t\t
Diet<\/span><\/div>\n\n\t\t\t
Exercise<\/span><\/div>\n\n\t\t\t
Work\/School<\/span><\/div>\n\t\t\t<\/td>\n\t\t\t
\n\t\t\t
Included:<\/strong> N\/A<\/div>\n\n\t\t\t
------------------------------------------------------------------------------------------------------<\/div>\n\n\t\t\t
Not Included:<\/strong> This is often missed during discharge teaching and frequently leads to follow up calls. It is not always on the forefront of the patient\/nurse mind following an MVC; however, after the patient returns home they typically start to think of these secondary challenges. <\/div>\n\t\t\t<\/td>\n\t\t<\/tr>\n\t\t
\n\t\t\t
Home and Community Care<\/strong><\/div>\n\n\t\t\t
OT (Occupational Therapy)<\/span><\/div>\n\n\t\t\t
PT (Physiotherapy)<\/span><\/div>\n\n\t\t\t
<\/span>RRN (Rapid Response Nurse)<\/span><\/div>\n\n\t\t\t
Wound care<\/span> <\/div>\n\t\t\t<\/td>\n\t\t\t
\n\t\t\t
Included:<\/strong> Including support services in discharge care provides a sense of comfort, knowing they will continue to be taken care of while at home. It also puts services in the home to give the patient the best chance of not requiring a return visit or deterioration in condition. <\/div>\n\n\t\t\t
-----------------------------------------------------------------------------------------------------<\/div>\n\n\t\t\t
Not Included<\/strong>: Involving PT to assist with increasing strength and range of motion to the affected limb will set the patient up for a strong recovery. A RRN will do medical reconciliation, provide regular nursing assessments, ensure the care plan is in place and help coordinate overall care.<\/div>\n\t\t\t<\/td>\n\t\t<\/tr>\n\t\t
\n\t\t\t
Follow-Up Appointments<\/strong><\/div>\n\n\t\t\t
Suture Removal<\/span><\/div>\n\t\t\t<\/td>\n\t\t\t
\n\t\t\t
Included:<\/strong> The patient knows how and when to have sutures removed, reducing the risk of a follow up phone call. Establishing an appointment prior to leaving the ED is the best way ensure procedured do not get missed. <\/div>\n\n\t\t\t
-------------------------------------------------------------------------------------------------------<\/div>\n\n\t\t\t
Not Included:<\/strong> N\/A<\/div>\n\t\t\t<\/td>\n\t\t<\/tr>\n\t<\/tbody>\n<\/table>\n"},"library":"H5P.Table 1.1","metadata":{"contentType":"Table","license":"U","title":"Discharge Teaching"},"subContentId":"eb46a4cc-8b3d-49cd-8b8d-c7a4b17f1c8a"},"useSeparator":"auto"}]},"library":"H5P.Column 1.16","subContentId":"8a13f31e-bb2e-4674-98ce-620c0c656b1e","metadata":{"contentType":"Column","license":"U","title":"Improvement Opportunity"}},{"params":{"content":[{"content":{"params":{"text":"
Thank you for participating in this learning opportunity. Please complete the post survey below to conclude the module. <\/span><\/span><\/p>\n\n
<\/p>\n"},"library":"H5P.AdvancedText 1.1","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"},"subContentId":"6c0527c1-e279-4bce-88ae-a5f3cb9f52ed"},"useSeparator":"auto"},{"useSeparator":"auto","content":{"params":{"linkWidget":{"protocol":"https:\/\/","url":"www.cognitoforms.com\/UniversityOfOttawa3\/dischargeteachingintheemergencydepartmentpostsurvey"},"title":"CLICK HERE for Discharge in the ED: Post-Survey"},"library":"H5P.Link 1.3","metadata":{"contentType":"Link","license":"U"},"subContentId":"60c663a8-6d77-4cdd-b2ce-c2b6f517f069"}},{"content":{"params":{"contentName":"Image","file":{"path":"images\/file-61ffdead5f31a.jpg","mime":"image\/jpeg","copyright":{"license":"U"},"width":1220,"height":860}},"library":"H5P.Image 1.1","metadata":{"contentType":"Image","license":"U","title":"Untitled Image"},"subContentId":"64ef0b96-e207-404e-a29b-203ef9d1e3bb"},"useSeparator":"auto"}]},"library":"H5P.Column 1.16","subContentId":"fa7344ab-b972-46af-9f39-7db44f628aa6","metadata":{"contentType":"Column","license":"U","title":"Post Survey"}},{"params":{"content":[{"content":{"params":{"text":"
References<\/p>\n\n
\n
\n
<\/p>\n\n
Hahn-Goldberg, T., <\/span><\/span><\/span><\/span>Chaput<\/span><\/span><\/span><\/span>, A., <\/span><\/span><\/span><\/span>Krahn<\/span><\/span><\/span><\/span>, M., <\/span><\/span><\/span><\/span>Rac<\/span><\/span><\/span><\/span>, V., Tomlinson, G., <\/span><\/span><\/span><\/span>Matelski<\/span><\/span><\/span><\/span>, J., Abrams, H., Bell, C., <\/span><\/span><\/span><\/span>Madho<\/span><\/span><\/span><\/span>, C., Ferguson, C., Turcotte, A., Free, C., Hogan, S., Nicholas, B., Oldershaw, B., & <\/span><\/span><\/span><\/span>Okrainec<\/span><\/span><\/span><\/span>, K. (2021). Implementation, spread and impact of the Patient Oriented Discharge Summary (PODS) across Ontario hospitals: a mixed methods evaluation. <\/span><\/span><\/span><\/span>BMC Health Services Research<\/span><\/span><\/span><\/span><\/span>, <\/span><\/span><\/span><\/span>21<\/span><\/span><\/span><\/span><\/span>(1), 361\u2013361. https:\/\/doi.org\/10.1186\/s12913-021-06374-8 <\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/p>\n\n
Hall<\/span><\/span><\/span><\/span>, J., Graham, J., McGowan, M., Cheng, A. (2018). Using written instructions to improve the quality of emergency department discharge communication: An interdisciplinary, patient centred approach. <\/span><\/span><\/span><\/span>American Journal of Medical Quality, 33<\/span><\/span><\/span><\/span><\/span>(2). <\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/p>\n\n
Marty, H., <\/span><\/span><\/span><\/span>Bogenstatter<\/span><\/span><\/span><\/span>, Y., Franc, G., <\/span><\/span><\/span><\/span>Tschan<\/span><\/span><\/span><\/span>, F., & Zimmermann, H. (2013). How well informed are patients when leaving the emergency department? Comparing information provided and information retained. <\/span><\/span><\/span><\/span>Emergency Medical Journal, <\/span><\/span><\/span><\/span><\/span>30(1), 53-57. <\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/p>\n\n
Samuels-<\/span><\/span><\/span><\/span>Kalow<\/span><\/span><\/span><\/span>, M., Stack, A., Porter, S. 2012. Effective discharge communication in the emergency department. <\/span><\/span><\/span><\/span>Annals of Emergency Medicine, 60<\/span><\/span><\/span><\/span><\/span>(2), 152-159<\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/p>\n\n
Sheikh, H., <\/span><\/span><\/span><\/span>Brezar<\/span><\/span><\/span><\/span>, A., <\/span><\/span><\/span><\/span>Dzwonek<\/span><\/span><\/span><\/span>, A., <\/span><\/span><\/span><\/span>Yau<\/span><\/span><\/span><\/span>, L., & Calder, L. (2018). Patient understanding of discharge instructions in the emergency department: do different patients need different approaches? <\/span><\/span><\/span><\/span>International Journal of Emergency Medicine, 11<\/span><\/span><\/span><\/span><\/span>(5).<\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/p>\n\n
Vashi, A., & Rhodes, K. (2011). \u201cSign right here and you\u2019re good to go\u201d: A content analysis of audiotaped emergency department discharge instructions. <\/span><\/span><\/span><\/span>Annals of Emergency Medicine, 57<\/span><\/span><\/span><\/span><\/span>(4), 315-322.<\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/p>\n"},"library":"H5P.AdvancedText 1.1","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"},"subContentId":"d4994334-d077-40f6-b1f7-d175062f86b6"},"useSeparator":"auto"}]},"library":"H5P.Column 1.16","subContentId":"658c2f79-db1b-4706-b6f1-d03738668773","metadata":{"contentType":"Column","license":"U","title":"References"}}],"behaviour":{"defaultTableOfContents":true,"progressIndicators":true,"progressAuto":true,"displaySummary":true},"read":"Read","displayTOC":"Display 'Table of contents'","hideTOC":"Hide 'Table of contents'","nextPage":"Next page","previousPage":"Previous page","chapterCompleted":"Page completed!","partCompleted":"@pages of @total completed","incompleteChapter":"Incomplete page","navigateToTop":"Navigate to the top","markAsFinished":"I have finished this page","fullscreen":"Fullscreen","exitFullscreen":"Exit fullscreen","bookProgressSubtext":"@count of @total pages","interactionsProgressSubtext":"@count of @total interactions","submitReport":"Submit Report","restartLabel":"Restart","summaryHeader":"Summary","allInteractions":"All interactions","unansweredInteractions":"Unanswered interactions","scoreText":"@score \/ @maxscore","leftOutOfTotalCompleted":"@left of @max interactions completed","noInteractions":"No interactions","score":"Score","summaryAndSubmit":"Summary & submit","noChapterInteractionBoldText":"You have not interacted with any pages.","noChapterInteractionText":"You have to interact with at least one page before you can see the summary.","yourAnswersAreSubmittedForReview":"Your answers are submitted for review!","bookProgress":"Book progress","interactionsProgress":"Interactions progress","totalScoreLabel":"Total score","a11y":{"progress":"Page @page of @total.","menu":"Toggle navigation menu"}}

Topic <\/strong><\/td>\n\t\t\t	Rationale<\/strong><\/td>\n\t\t<\/tr>\n\t\t
\n\t\t\t Discharge Diagnosis<\/strong><\/div>\n\n\t\t\t Radial Fracture <\/span><\/div>\n\n\t\t\t Laceration <\/span><\/div>\n\n\t\t\t C<\/span>oncussion <\/span><\/div>\n\n\t\t\t <\/div>\n\t\t\t<\/td>\n\t\t\t	\n\t\t\t Included:<\/strong> The nurse discussed both the laceration and fracture providing the patient and her mom with suture care and follow-up information<\/div>\n\n\t\t\t ------------------------------------------------------------------------------------------------------<\/div>\n\n\t\t\t Not Included:<\/strong> Patient's who experience concussions can have delayed symptom onset and require teaching on what is normal and can be treated at home, and when to return to the hospital for further assessment. <\/div>\n\t\t\t<\/td>\n\t\t<\/tr>\n\t\t
\n\t\t\t When to Return to Hospital<\/strong><\/div>\n\n\t\t\t Signs of infection <\/span><\/div>\n\n\t\t\t Signs of compartment syndrome <\/span><\/div>\n\n\t\t\t <\/div>\n\t\t\t<\/td>\n\t\t\t	\n\t\t\t Included:<\/strong> The nurse did a great job providing teaching on what signs of infection to watch for, and when to return to hospital. This ultimately could save the patients life if she became septic. With a large wound on the L upper arm, close to the heart, a severe infection could put the patient's life in jeopardy quickly, she should be reassessed and started on antibiotics at the first sign of infection. <\/div>\n\n\t\t\t -----------------------------------------------------------------------------------------------------<\/div>\n\n\t\t\t Not Included<\/strong>: The nurse forgot to do teaching on compartment syndrome, which should be closely monitored for with any patient who has been casted to prevent loss of blood flow and risk of limb loss<\/div>\n\t\t\t<\/td>\n\t\t<\/tr>\n\t\t
\n\t\t\t Medication Review<\/strong> <\/div>\n\n\t\t\t Dilaudid <\/span><\/div>\n\n\t\t\t Non-prescribed <\/span>Medications<\/span><\/div>\n\t\t\t<\/td>\n\t\t\t	\n\t\t\t Included: <\/strong>This helps the patient feel more confident in managing new medication at home<\/div>\n\n\t\t\t -----------------------------------------------------------------------------------------------------<\/div>\n\n\t\t\t Not Included:<\/strong> The importance of regular Tylenol\/Advil for pain management and to reduce swelling. Over the counter medications that could be used to counter the constipating effects of Dialudid such as Colace or Restoralax. It's always a good idea to refer the patient to their local pharmacist for any further medication related questions. <\/div>\n\t\t\t<\/td>\n\t\t<\/tr>\n\t\t
\n\t\t\t Changes to Routine<\/strong><\/div>\n\n\t\t\t Diet<\/span><\/div>\n\n\t\t\t Exercise<\/span><\/div>\n\n\t\t\t Work\/School<\/span><\/div>\n\t\t\t<\/td>\n\t\t\t	\n\t\t\t Included:<\/strong> N\/A<\/div>\n\n\t\t\t ------------------------------------------------------------------------------------------------------<\/div>\n\n\t\t\t Not Included:<\/strong> This is often missed during discharge teaching and frequently leads to follow up calls. It is not always on the forefront of the patient\/nurse mind following an MVC; however, after the patient returns home they typically start to think of these secondary challenges. <\/div>\n\t\t\t<\/td>\n\t\t<\/tr>\n\t\t
\n\t\t\t Home and Community Care<\/strong><\/div>\n\n\t\t\t OT (Occupational Therapy)<\/span><\/div>\n\n\t\t\t PT (Physiotherapy)<\/span><\/div>\n\n\t\t\t <\/span>RRN (Rapid Response Nurse)<\/span><\/div>\n\n\t\t\t Wound care<\/span> <\/div>\n\t\t\t<\/td>\n\t\t\t	\n\t\t\t Included:<\/strong> Including support services in discharge care provides a sense of comfort, knowing they will continue to be taken care of while at home. It also puts services in the home to give the patient the best chance of not requiring a return visit or deterioration in condition. <\/div>\n\n\t\t\t -----------------------------------------------------------------------------------------------------<\/div>\n\n\t\t\t Not Included<\/strong>: Involving PT to assist with increasing strength and range of motion to the affected limb will set the patient up for a strong recovery. A RRN will do medical reconciliation, provide regular nursing assessments, ensure the care plan is in place and help coordinate overall care.<\/div>\n\t\t\t<\/td>\n\t\t<\/tr>\n\t\t
\n\t\t\t Follow-Up Appointments<\/strong><\/div>\n\n\t\t\t Suture Removal<\/span><\/div>\n\t\t\t<\/td>\n\t\t\t	\n\t\t\t Included:<\/strong> The patient knows how and when to have sutures removed, reducing the risk of a follow up phone call. Establishing an appointment prior to leaving the ED is the best way ensure procedured do not get missed. <\/div>\n\n\t\t\t -------------------------------------------------------------------------------------------------------<\/div>\n\n\t\t\t Not Included:<\/strong> N\/A<\/div>\n\t\t\t<\/td>\n\t\t<\/tr>\n\t<\/tbody>\n<\/table>\n"},"library":"H5P.Table 1.1","metadata":{"contentType":"Table","license":"U","title":"Discharge Teaching"},"subContentId":"eb46a4cc-8b3d-49cd-8b8d-c7a4b17f1c8a"},"useSeparator":"auto"}]},"library":"H5P.Column 1.16","subContentId":"8a13f31e-bb2e-4674-98ce-620c0c656b1e","metadata":{"contentType":"Column","license":"U","title":"Improvement Opportunity"}},{"params":{"content":[{"content":{"params":{"text":" Thank you for participating in this learning opportunity. Please complete the post survey below to conclude the module. <\/span><\/span><\/p>\n\n <\/p>\n"},"library":"H5P.AdvancedText 1.1","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"},"subContentId":"6c0527c1-e279-4bce-88ae-a5f3cb9f52ed"},"useSeparator":"auto"},{"useSeparator":"auto","content":{"params":{"linkWidget":{"protocol":"https:\/\/","url":"www.cognitoforms.com\/UniversityOfOttawa3\/dischargeteachingintheemergencydepartmentpostsurvey"},"title":"CLICK HERE for Discharge in the ED: Post-Survey"},"library":"H5P.Link 1.3","metadata":{"contentType":"Link","license":"U"},"subContentId":"60c663a8-6d77-4cdd-b2ce-c2b6f517f069"}},{"content":{"params":{"contentName":"Image","file":{"path":"images\/file-61ffdead5f31a.jpg","mime":"image\/jpeg","copyright":{"license":"U"},"width":1220,"height":860}},"library":"H5P.Image 1.1","metadata":{"contentType":"Image","license":"U","title":"Untitled Image"},"subContentId":"64ef0b96-e207-404e-a29b-203ef9d1e3bb"},"useSeparator":"auto"}]},"library":"H5P.Column 1.16","subContentId":"fa7344ab-b972-46af-9f39-7db44f628aa6","metadata":{"contentType":"Column","license":"U","title":"Post Survey"}},{"params":{"content":[{"content":{"params":{"text":" References<\/p>\n\n \n \n <\/p>\n\n Hahn-Goldberg, T., <\/span><\/span><\/span><\/span>Chaput<\/span><\/span><\/span><\/span>, A., <\/span><\/span><\/span><\/span>Krahn<\/span><\/span><\/span><\/span>, M., <\/span><\/span><\/span><\/span>Rac<\/span><\/span><\/span><\/span>, V., Tomlinson, G., <\/span><\/span><\/span><\/span>Matelski<\/span><\/span><\/span><\/span>, J., Abrams, H., Bell, C., <\/span><\/span><\/span><\/span>Madho<\/span><\/span><\/span><\/span>, C., Ferguson, C., Turcotte, A., Free, C., Hogan, S., Nicholas, B., Oldershaw, B., & <\/span><\/span><\/span><\/span>Okrainec<\/span><\/span><\/span><\/span>, K. (2021). Implementation, spread and impact of the Patient Oriented Discharge Summary (PODS) across Ontario hospitals: a mixed methods evaluation. <\/span><\/span><\/span><\/span>BMC Health Services Research<\/span><\/span><\/span><\/span><\/span>, <\/span><\/span><\/span><\/span>21<\/span><\/span><\/span><\/span><\/span>(1), 361\u2013361. https:\/\/doi.org\/10.1186\/s12913-021-06374-8 <\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/p>\n\n Hall<\/span><\/span><\/span><\/span>, J., Graham, J., McGowan, M., Cheng, A. (2018). Using written instructions to improve the quality of emergency department discharge communication: An interdisciplinary, patient centred approach. <\/span><\/span><\/span><\/span>American Journal of Medical Quality, 33<\/span><\/span><\/span><\/span><\/span>(2). <\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/p>\n\n Marty, H., <\/span><\/span><\/span><\/span>Bogenstatter<\/span><\/span><\/span><\/span>, Y., Franc, G., <\/span><\/span><\/span><\/span>Tschan<\/span><\/span><\/span><\/span>, F., & Zimmermann, H. (2013). How well informed are patients when leaving the emergency department? Comparing information provided and information retained. <\/span><\/span><\/span><\/span>Emergency Medical Journal, <\/span><\/span><\/span><\/span><\/span>30(1), 53-57. <\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/p>\n\n Samuels-<\/span><\/span><\/span><\/span>Kalow<\/span><\/span><\/span><\/span>, M., Stack, A., Porter, S. 2012. Effective discharge communication in the emergency department. <\/span><\/span><\/span><\/span>Annals of Emergency Medicine, 60<\/span><\/span><\/span><\/span><\/span>(2), 152-159<\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/p>\n\n Sheikh, H., <\/span><\/span><\/span><\/span>Brezar<\/span><\/span><\/span><\/span>, A., <\/span><\/span><\/span><\/span>Dzwonek<\/span><\/span><\/span><\/span>, A., <\/span><\/span><\/span><\/span>Yau<\/span><\/span><\/span><\/span>, L., & Calder, L. (2018). Patient understanding of discharge instructions in the emergency department: do different patients need different approaches? <\/span><\/span><\/span><\/span>International Journal of Emergency Medicine, 11<\/span><\/span><\/span><\/span><\/span>(5).<\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/p>\n\n Vashi, A., & Rhodes, K. (2011). \u201cSign right here and you\u2019re good to go\u201d: A content analysis of audiotaped emergency department discharge instructions. <\/span><\/span><\/span><\/span>Annals of Emergency Medicine, 57<\/span><\/span><\/span><\/span><\/span>(4), 315-322.<\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/p>\n"},"library":"H5P.AdvancedText 1.1","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"},"subContentId":"d4994334-d077-40f6-b1f7-d175062f86b6"},"useSeparator":"auto"}]},"library":"H5P.Column 1.16","subContentId":"658c2f79-db1b-4706-b6f1-d03738668773","metadata":{"contentType":"Column","license":"U","title":"References"}}],"behaviour":{"defaultTableOfContents":true,"progressIndicators":true,"progressAuto":true,"displaySummary":true},"read":"Read","displayTOC":"Display 'Table of contents'","hideTOC":"Hide 'Table of contents'","nextPage":"Next page","previousPage":"Previous page","chapterCompleted":"Page completed!","partCompleted":"@pages of @total completed","incompleteChapter":"Incomplete page","navigateToTop":"Navigate to the top","markAsFinished":"I have finished this page","fullscreen":"Fullscreen","exitFullscreen":"Exit fullscreen","bookProgressSubtext":"@count of @total pages","interactionsProgressSubtext":"@count of @total interactions","submitReport":"Submit Report","restartLabel":"Restart","summaryHeader":"Summary","allInteractions":"All interactions","unansweredInteractions":"Unanswered interactions","scoreText":"@score \/ @maxscore","leftOutOfTotalCompleted":"@left of @max interactions completed","noInteractions":"No interactions","score":"Score","summaryAndSubmit":"Summary & submit","noChapterInteractionBoldText":"You have not interacted with any pages.","noChapterInteractionText":"You have to interact with at least one page before you can see the summary.","yourAnswersAreSubmittedForReview":"Your answers are submitted for review!","bookProgress":"Book progress","interactionsProgress":"Interactions progress","totalScoreLabel":"Total score","a11y":{"progress":"Page @page of @total.","menu":"Toggle navigation menu"}}

Discharge Teaching in the Emergency Department

Kaley Lapierre