122 Chapter 6 Abstract Background With the ‘teach-back’ method, patients or proxies repeat back what they understand so that professionals can confirm their comprehension and correct misunderstandings. The effectiveness of teach-back has been underexamined, particularly for older patients discharged from the emergency department (ED). Objective We aimed to determine whether teach-back would reduce ED revisits and if it would increase patients’ knowledge retention of discharge instructions, improve self-management at home and increase satisfaction with the provision of discharge instructions. Methods A nonrandomized pre-post pilot evaluation in the ED of one Dutch academic hospital including patients discharged from the ED receiving standard discharge care (pre) and teach-back (post). Primary outcomes were ED-revisits within 7 days and within 8 to 30 days postdischarge. Secondary outcomes for a subsample (adults aged ≥70 years) were knowledge retention of the instructions, self- management 72 hours after discharge, and satisfaction with the provision of the discharge instructions. Results A total of 648 patients were included, among which 154 were older adults. ED revisits within 7 days and within 8 to 30 days were significantly lower in the teach-back group: adjusted odds ratios of 0.23 (95% confidence interval 0.05 to 1.07) and 0.42 (95% confidence interval 0.14 to 1.33), respectively. Participants in the teach-back group had an increased likelihood of full knowledge retention on information related to their ED diagnosis and treatment (adjusted odds ratio 2.19; 95% confidence interval 1.01 to 4.75), medication (adjusted odds ratio 11.25; 95% confidence interval 3.45 to 36.65) and follow-up appointments (adjusted odds ratio 3.56; 95% confidence interval 1.36 to 9.31). At home, they were more confident in determining when medical care was necessary than their counterparts receiving standard discharge care (p=0.002). Discharge conversations were generally shorter for participants receiving teach-back. Conclusion Discharging patients from the ED with a relatively simple and feasible teach-back method can contribute to safer and better transitional care from the ED to home.
RkJQdWJsaXNoZXIy MjY0ODMw