126 Chapter 6 the elements of the teach-back training. Additional training sessions in the post-intervention phase were held for new employees, especially a large group of residents working for several weeks in the ED as part of their residency programme. In total, 37 ED nurses, 7 ED physicians and 37 medical residents were trained. During the post-intervention phase, C.T. and N.K. randomly attended discharge conversations. For the subsample of older participants, all discharge conversations were attended. Immediate feedback to professionals was provided to enhance awareness of and improvement of teach-back. Outcome measures and sample size The primary outcomes were ED revisits within 7 days and within 8 to 30 days post-index visit. Previous studies reported that teach-back can reduce hospital readmissions by 4–12% for hospitalized patients at high risk of acute conditions. [30, 31] Based on these findings, the annual ED revisit rate within 30 days in our hospital,[32] and taking into account that this study was performed in the ED setting, we estimated at least a 7% reduction in ED revisits from 14% to 7%. To achieve 80% power to detect this 7% difference in the primary outcome between study groups, with the two-tailed alpha set at 0.05, we calculated that aminimum of 300 patients in each study group would be required. Secondary outcomes included older participants’ knowledge retention of discharge instructions across the five information domains, reported self-management at home and satisfaction the with discharge instructions provided by professionals in the ED. Data collection Medical chart review Baseline data on age, sex, urgency level (based on the urgency classification levels of the Manchester Triage System; MTS), comorbidity level (based on the Charlson Comorbidity Index; CCI), polypharmacy (defined as ≥5 different types of prescribed medications), ED length of stay (LOS) and time of ED discharge were obtained from the patient’s electronic medical record (EMR) along with the noted discharge instructions. Furthermore, data about ED revisits within 7 days and within 8 to 30 days post-index visit were collected from the EMR. Observation of discharge conversations N.K. and C.T. attended discharge conversations between professionals and older patients (aged ≥70 years) or their proxies. The duration of the discharge conversation was timed, and the provided instructions were noted according to a structured format (supplement 2), focusing on five critical information domains: 1) ED diagnosis and treatment, 2) (prescribed) medication in the ED, 3)
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