131 Teach-back of discharge instructions in the ED CHAPTER 6 the standard discharge group and 67 (48.9%) in the teach-back group. No significant baseline differences were found between the groups except for older adults having a higher CCI in the standard discharge group (p=0.01) and more older adults with cognitive impairment at the time of ED discharge in the teach-back group (p=0.04) (table 1). Discharge conversations lasted longer for participants receiving standard discharge care than for those receiving teach-back, withmedians of 7min (IQR, 5–10) and 5min (IQR, 3–9), respectively. ED revisits We observed pre–post differences in ED revisits within 7days and within 8–30 days postindex visit (table 2). Participants receiving teach-back had a reduced likelihood of an ED revisit within 7days and within 8–30 days compared with participants receiving standard discharge care. These associations were not statistically significant after controlling for age, sex, urgency triage level, comorbidity level, ED LOS and ED discharge during peak time. Knowledge retention of older adults Interrater agreement of knowledge retention on the five domains varied between 0.7 (ie, instructions on ED diagnosis and treatment) and 0.9 (ie, instructions on return precautions). Time plots and histograms do not show clear secular trends in improved retention prior to the use of teach-back (figure 2; supplement 5). Deficits in knowledge retention were noted between the study groups in each information domain (table 3). Almost one-third of the participants receiving standard discharge care showed partial to no retention on each of the five information domains. Full knowledge retention of the instructions was numerically higher in all five information domains for participants receiving teach-back. Table 2 Associations between the use of teach-back (versus standard discharge care) and ED return visits Standard discharge (n=343) Teachback (n=305) OR (95% CI) AOR (95% CI)† ED return visits within 7 days of the index visit, n (%) 17 (5.0) 3 (1.0) 0.19 (0.06-0.66) 0.23 (0.05-1.07) ED return visits 8-30 days of the index visit, n (%) 17 (5.0) 5 (1.6) 0.32 (0.12-0.88) 0.42 (0.14-1.33) † Adjusted for age, gender, urgency triage level (high/low), comorbidity level (Charlson Comorbidity Index) ED length of stay and ED discharge during the peak time. ED, Emergency Department; OR, Odds Ratio; CI, Confidence Interval; AOR, Adjusted Odds Ratio.
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