(1) Develop and Pilot Test a Prototype ED Discharge Tool in a limited
number of settings to assess:
(A) The feasibility for use with patients;
(B) The methodological and resource requirements associated with tool use;
(C) The feasibility of measuring outcomes;
(D) The costs of implementation and;
(E) Treliminary outcomes or impacts of tool use.
(2) Revise the Tool based on the results from the Pilot Test
This study is being conducted by AHRQ through its contractor,
Method of Collection
To achieve these goals the following data collections will be implemented:
(1) Emergency Department Discharge Tool (EDT)--The EDT will be pilot tested in the three John Hopkins EDs in
For those flagged as frequent ED users this tool uses data collected from the patient's record and from the patient himself to identify individuals with risk factors that have been shown in the literature to predict sub-optimal ED discharges and resulting revisits. These risk factors include patients who are uninsured, lack a primary care physician, have psychiatric diseases, are substance users, have difficulty caring for themselves, or have trouble comprehending ED discharge instructions.
A user's manual (EDT User's Manual) is also provided to assist EDs in developing resources to provide interventions recommended by the EDT. No data collection activities will be made from this manual.
(2) One Month Patient Follow-up--After the ED visit, a project research assistant (RA) will have a follow-up telephone interview with all enrolled patients. During the interview, the RA will inquire about the patient's remembrance of the instructions that were given for the patient.
(3) Three Month Patient Follow-up--Patients who are uninsured will receive an additional phone call 3 months after the ED visit to assess whether or not they were able to acquire insurance.
(4) Post Pilot Test Focus Groups--AHRQ will conduct three sets of focus groups to collect qualitative data about the usability and usefulness of the EDT from three stakeholder groups: EDT implementers, patients, and post-ED care providers. Questions for each of the focus groups will vary based on their differing objectives:
(A) EDT Implementers Focus Group--For implementers of the EDT (RNs, case managers, social workers, research assistants), the objectives will include: (1) How well it does or does not meet implementer goals of discharge; (2) resources required for implementation; and (3) unintended consequences or impacts on other ED operations.
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