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Child Passenger Safety Resources in EDs

Child Passenger Safety Resources in EDs

Each year in the United States, more than 130,000 children younger than age 13 are treated in EDs after motor vehicle collisions (MVCs). MVCs are a leading cause of death in U.S. children, in part because child passengers continue to be inappropriately restrained. Studies have shown that 20% of children aged 1 to 3 years and nearly 50% of those aged 4 to 7 years do not use the recommended restraint for their age. MVC-related ED visits for children offer a chance for ED personnel to convey tips for proper use of child passenger restraints to prevent future injuries. Missing Key Opportunities Recently, my colleagues and I published a study in Pediatric Emergency Care that examined emergency physician awareness of and referrals to child passenger safety resources. Our results suggest that many EDs aren’t taking advantage of opportunities to educate families on child passenger safety. The survey, which included responses from more than 600 emergency physicians drawn from a national sample, found significant variability by practice setting in the availability of child passenger safety resources. More than one-third of responding ED physicians reported uncertainty about whether their departments provided child passenger safety resources to parents. Less than half of respondents said that a parent of a 2-year-old being discharged following an MVC would be provided with discharge instructions that include advice about car seats. Our analysis also revealed that only half of pediatric trauma center physicians would always recommend replacing a 3-year-old’s car seat following a roll-over MVC, and even fewer adult and non-trauma center physicians would do so. Children seen in general EDs without pediatric specialization were least...
Knowledge Deficits at ED Discharge

Knowledge Deficits at ED Discharge

Effective communication between caregivers and patients is a critical element of providing high-quality patient care in the ED. In recent years, a greater emphasis has been placed on information delivery at ED discharge and its downstream implications for adherence and outcomes. “Despite recognizing the importance of communication, the complex ED environment can make it challenging to communicate effectively,” says Kirsten G. Engel, MD. “Many patients leave the ED with an incomplete understanding of their care and instructions.” (see also, Communicating More Effectively at ED Discharge) The causes of poor communication at ED discharge are multifactorial and likely reflect problems with both written and verbal communication. Written discharge instructions often exceed patients’ health literacy or reading levels, and verbal communication is frequently brief and incomplete. Previous research has suggested that the majority of patients have a comprehension deficit for at least one area of their ED care and instructions, with the most frequent deficits found in the domain of post-ED care. “The effect of poor discharge communication is profound because many patients are leaving the ED without the knowledge they need to properly care for themselves at home,” Dr. Engel says. “This increases their risk for adverse events, as well as repeat ED visits and hospitalization.” Deficits in Patient Understanding at Discharge To address problems with information delivery at ED discharge, Dr. Engel says it is essential to better define deficits in patients’ understanding of discharge instructions. “We need to characterize knowledge gaps that may put patients at risk for complications or poor outcomes following their ED visits,” she adds. “Identifying these areas serves as a critical next step in...
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