Luna-Arana Carmen, Castro-Rodríguez Cristina, Jové-Blanco Ana, Mora-Capín Andrea, Ferrero García-Loygorri Clara, Vázquez-López Paula
Author Affiliations: Pediatric Emergency Department (Mss Luna-Arana, Castro-Rodríguez, Jové-Blanco, Mora-Capín, and García-Loygorri and Dr Vázquez-López), Gregorio Marañón Health Research Institute, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Qual Manag Health Care. 2024 Nov 4. doi: 10.1097/QMH.0000000000000463.
Fever is a frequent cause of consultation in the pediatric emergency department (PED). Adequate discharge instructions are essential to guarantee good management at home and can reduce caregivers' anxiety and re-consultations. This study compares the improvement of caregivers' knowledge regarding fever between verbal discharge instructions and the addition of a video to verbal information. As a secondary outcome, we compared the rate of return visits.
An experimental, prospective, single-center study was conducted in a tertiary hospital PED. Patients between 3 months and 5 years old with febrile syndrome were enrolled. Patients with comorbidities or SARS-COV2 infection were excluded. First, caregivers answered a written test concerning fever characteristics, management, and warning signs. Patients were assigned by simple randomization to a control group (standard verbal and written instructions) or to an intervention group (which additionally received video instructions). After discharge, investigators contacted caregivers by telephone. Caregivers were asked to answer the same questions as in the written test in addition to the need for subsequent visits (at the PED or any other healthcare facility) after discharge.
Seventy-three patients were randomized to the intervention group and 77 to the control group (2 were lost during follow-up). There were no differences in the acquisition of caregiver's knowledge, with a median score improvement of 2 points in both groups (control group interquartile range (IQR) 1-2; intervention group IQR 1-3) (P = .389). In the intervention group, we observed a significant increase of correct answers in 4 out of 7 questions compared to 3 out of 7 questions in the control group. In the control group, 18.7% reconsulted compared to 10.9% in the intervention group (P = .188).
Video instructions were not superior to verbal instructions at improving caregivers' knowledge of fever overall. However, more questions obtained a significant score increase in those that received video and verbal instructions. Our results suggest that the addition of video instructions could help reduce return visits.
发热是儿科急诊科（PED）常见的就诊原因。充分的出院指导对于确保在家中得到良好护理至关重要，并且可以减轻护理人员的焦虑并减少再次就诊的情况。本研究比较了口头出院指导与在口头信息中添加视频对护理人员关于发热知识的改善情况。作为次要结果，我们比较了复诊率。
在一家三级医院的儿科急诊科进行了一项实验性、前瞻性、单中心研究。纳入3个月至5岁患有发热综合征的患者。排除患有合并症或SARS-CoV-2感染的患者。首先，护理人员回答一份关于发热特征、护理及警示信号的书面测试。通过简单随机化将患者分配至对照组（标准口头和书面指导）或干预组（额外接受视频指导）。出院后，研究人员通过电话联系护理人员。除了询问出院后是否需要后续就诊（在儿科急诊科或任何其他医疗机构）外，还要求护理人员回答与书面测试相同的问题。
73例患者被随机分配至干预组，77例至对照组（2例在随访期间失访）。护理人员知识掌握情况无差异，两组的中位数得分均提高了2分（对照组四分位间距（IQR）为1 - 2；干预组IQR为1 - 3）（P = 0.389）。在干预组中，7个问题中有4个问题的正确答案显著增加，而对照组7个问题中有3个问题正确答案增加。对照组的复诊率为18.7%，干预组为10.9%（P = 0.188）。
总体而言，视频指导在提高护理人员对发热的认识方面并不优于口头指导。然而，在接受视频和口头指导的人群中，更多问题的得分有显著提高。我们的结果表明，添加视频指导可能有助于减少复诊。
