137 Teach-back of discharge instructions in the ED CHAPTER 6 interview. We tried to control for this by calling back unavailable participants multiple times and by varying call-back times. Participants were also only recruited during office hours. Potentially confounding factors (eg, perceived work pressure by ED professionals) related to the discharge of patients out-of-hours may have been overlooked. Moreover, non-Dutch-speaking patients were excluded because of translation issues while this group would perhaps benefit the most from teach-back although via an interpreter. Seventh, we were not able to determine whether the pre–post differences in observed ED return visits were caused by better knowledge retention or self-management resulting from teach-back at discharge. Other external factors (eg, exacerbations) may have led to an inevitable ED revisit. Therefore, our findings need to be interpreted with caution. Finally, other confounding factors not adjusted for in the multivariable analysis could be another limitation. The bias that may be introduced by all of these factors requires a more rigid methodology, for which we think that a multicentre stepped wedge design would be ideal. Future studies should also adjust for health literacy level, as previous literature has shown that low literacy patients in particular might benefit from teach-back [11,51]. In summary, this pilot study shows that teach-back is a feasible method that supports professionals in the ED in discharge communication with patients and carers and can contribute to safer and better transitional care from the ED to home. Managers, professionals and educators, therefore, need to consider implementing teach-back as a standard element of the discharge process in the ED. The integration of teach-back into routine discharge practice can be stimulated by the use of a variety of available educational resources and implementation guides.52–54 The positive results of our pilot warrant further investigation in a larger clinical trial to provide more evidence for structural implementation of teach-back in the ED, as it can be a feasible and valuable intervention to reduce the risks at discharge from EDs. Funding This study was funded by the ‘Affordable Better’ (in Dutch: ‘Betaalbaar Beter’) quality improvement programme of the Radboud University Medical Center and the Dutch health insurer VGZ.
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