Use of a Discharge Facilitator Improves Recall of Emergency Department Discharge Instructions for Acute Gastroenteritis

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Abstract
To determine whether the use of a bilingual discharge facilitator (DF) improves parental recall of discharge instructions in acute gastroenteritis in a pediatric emergency department (ED). A nonrandomized educational intervention study with a historical control was conducted in a tertiary children's hospital between January 2004 and November 2004. English- or Spanish-speaking parents of patients aged 3 months to 18 years with conditions diagnosed as acute gastroenteritis were eligible. The standard discharge group received written discharge instructions and standard ED discharge protocols. The intervention group received the written discharge instructions reinforced verbally by the DF in the parent's language of choice. Recall of 7 warning signs and symptoms was assessed 24 to 48 hours after the ED visit for both groups. For the English-speaking subgroup, a mean of 3.5 (95% confidence interval [CI], 3.26-3.78) signs or symptoms was identified correctly by 71 subjects in the standard discharge group, and a mean of 4.1 (95% CI, 3.83-4.43) signs or symptoms was identified correctly by 94 subjects in the DF group. For the Spanish-speaking subgroup, a mean of 3.0 (95% CI, 2.67-3.36) signs or symptoms was identified correctly by 62 subjects in the standard discharge group, and a mean of 4.5 (95% CI 4.18-4.88) signs or symptoms was identified correctly by 64 subjects in the DF group. The differences remained significant after adjusting for patient age and the highest level of education attained by the parent. Verbal reinforcement of written discharge instructions by a bilingual DF improves parental recall of discharge instructions for gastroenteritis.

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