128 Chapter 6 normality of distribution. Frequencies and percentages were used for categorical variables. Cohen’s kappa scores were calculated to determine the interrater agreement on knowledge retention. To facilitate modelling, scores on ED discharge time were dichotomized into outside and during peak hours (noon to 6 pm). MTS urgency level scores were dichotomized into high (MTS category ‘immediate’ and ‘very urgent’) and low (MTS category ‘urgent’ and ‘standard’ and ‘nonurgent’).[35] Knowledge retention scores were dichotomized into: ‘full retention’ and ‘partial, minimal or no retention’. Scores on the self-reliance statements were dichotomized into ‘(strongly) agree’ and ‘(strongly) disagree’. We used Pearson’s chi-squared test for the comparison of dichotomous data and the unpaired t-test for continuous data. Nonnormally distributed data were compared by a Mann-Whitney U test after determining the normality of the data by the Kolmogorov-Smirnov test and the assessment of skewness and kurtosis. Univariable and multivariable logistic regression analyses were then performed to yield odds ratios (ORs) and adjusted odds ratios (AORs) with 95% confidence intervals. Covariates adjusted for in the multivariable models were: age, sex, urgency triage level, ED LOS, ED discharge during peak time, comorbidity level and cognitive impairment. The Hosmer-Lemeshow goodnessof-fit test was applied to evaluate the model fit. A statistically significant difference was set at p≤0.05. Analyses were conducted using SPSS Statistics version 23.0. Finally, interview audio recordings were analysed by one researcher to explore participants’ experiences with teach-back. Illustrative quotes were selected and transcribed. Results Description of the study sample Throughout the study period, 13,388 visits were registered at the ED and these cases were assessed for eligibility. In total, 648 patients were eligible to participate and consented, with 343 (52.9%) who received standard discharge care and 305 (47.1%) who received teach-back at discharge (Figure 1). The baseline characteristics of the pre- and post-intervention groups are shown in Table 1. No statistically significant differences were observed for age, sex, urgency triage level, comorbidity level, polypharmacy, duration of discharge instructions or ED discharge during busy hours. However, patients in the standard discharge group stayed significantly longer in the ED (median of 143 vs 131 min; p=0.03). Of the 648 eligible participants, 377 were older adults (figure 1). Two hundred and twenty-three cases were not recruited for secondary analyses due to various reasons. Seventeen older adults were lost to follow-up, resulting in 70 (51.1%) in
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