161 General discussion and future perspectives CHAPTER 7 retention will be sufficient because it is clinically relevant. We cannot know this for sure without longitudinally studying this assumption. We believe that future studies will have to point out whether knowledge retention is also sufficient in the long term. If not, the education program should be adjusted, or repeat sessions should be organized. The findings of our teach-back study showed that it is feasible to implement teach-back in an ED setting. Previous studies have questioned the feasibility of teach-back in the ED setting, as teach- back might be time consuming and extend discharge time (30, 31). Contrary to these studies, our study showed that teach-back results in even shorter discharge conversations. While some studies have reported that teach-back might be perceived as a patronizing method to examine whether information is understood (32, 33), our study showed high satisfaction with the teach-back method by patients and carers. Our study also showed that the implementation of teach-back improved patients’ knowledge retention. Although published data show that improved knowledge retention results in better decisions affecting patients’ health (34-37), our study showed no reduction in ED revisits. We speculate that ED revisits depend not only on knowledge retention but also on multiple other factors, such as triage level, comorbidity level, ED length of stay, and polypharmacy. While we adjusted/ controlled our results for age, sex, triage level, comorbidity level, ED length of stay and ED discharge during peak time, we did not adjust for polypharmacy. Studies have shown that patients with polypharmacy are more likely to revisit the ED than patients without polypharmacy (38, 39). It could be that the presence of polypharmacy affected our outcome variables. Although our study showed positive results, larger clinical trials – also assessing polypharmacy as an explanatory variable for ED revisits – are needed to confirm the benefits of implementing teach-back in the ED. The contrasting findings of another study may be explained by the older patient population in that study being relatively functionally independent compared to other elderly populations (40). Reflections on challenges of performing educational program research in the emergency department Performing research in the dynamic environment of an ED comes with practical challenges. The ED is usually crowded, which limits time for the implementation of research and poses the risk of interruption. Another challenge is that even though the ED often comprises many clinicians, the size of the research teams in the ED is often not proportional to the number of physicians. Despite these difficulties and complexities, the ED offers opportunities for large quantitative research projects as well as qualitative studies due to both the diversity and the number of patients presenting to the ED.
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