Faculty of Medicine
Faculty of Medicine
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[FG] Bingisser Roland

Projects & Collaborations

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Defining the need for analgesia in the emergency department: protocol for an international Delphi Process

Research Project  | 12 Project Members

Introduction

The high prevalence of pain in the emergency department (ED) highlights the importance of an accurate assessments to provide effective interventions. However, common pain scales such as the numerical pain rating scale have shown limitations in assessing analgesic requirements and adequacy. The ideal outcome for evaluating a pain scale predicting analgesic requirements would be the “need for analgesia”, for which there is no universally accepted definition. Accordingly, the primary aim of this study is to define the “need for analgesia” using an interdisciplinary approach. The secondary aim is to define the “adequacy of analgesia”.


Methods and analysis

A two-stage modified Delphi process will be conducted by a core study group chosen for its expertise in ED pain management. A larger expert panel, identified through a comprehensive search in Scopus and CINAHL databases, will be invited to participate in the study and will be supplemented by patients recruited via International Patient Organizations. In Stage 1, the expert panel will complete a written survey to collect potential clinical variables for defining the “need for analgesia” and “adequacy of analgesia”. The core study group will elaborate these variables. In stage 2, the same participants will use a five-point Likert scale to achieve consensus defined as 80% of combined agreement on the proposed variables. The same process will be used to define the “adequacy of analgesia”.


Ethics and Dissemination

The Ethics Committee of Northwestern and Central Switzerland exempted the project from committee approval under the Human Research Act. Written consent will be obtained from all participants. Results will be disseminated through publication in peer-reviewed journals and conferences. 

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Improving Discharge Communication in the Emergency Department through Information Structuring: A Cluster Randomized Controlled Trial

Research Project  | 3 Project Members

BackgroundIn an emergency department, effective discharge communication-the communicationi.e. information on of diagnosis diagnoses information as well asand instructions for the ongoingon further management of patients' conditions given by an attending physician at the time of discharge-represents a key step in medical care, with the potential to improve patient well-being and satisfaction, adherence to medication, and, ultimately, better health outcomes. Past research suggests that physicians' communication is often not optimally structured and that patients fail to fully recall and understand the information received at discharge. In turn, psychological research suggests that information structuring can be a powerful tool to improve memory recall and understanding. Consequently, information structuring represents a possible tool to improve discharge communication and associated patient outcomes.1.2. Goal and HypothesisThe goal of the proposed study is to assess the potential of information structuring for improving discharge communication. Specifically, we aim to examine the advantages of an information structuring skills training for physicians (relative tocompared to an emotion skills training) on discharge communication and associated patient outcomes, such as patients' information recall and adherence to physician recommendations. We hypothesize that patients receiving structured discharge information from their trained physicians will be able to recall more information and show higher adherence to recommendations relative to controls (i.e., patients receiving discharge information from doctors trained on emotion- handling skills).1.3. Study DesignThe study will use a cluster randomized controlled trial: by which clusters of physicians (cohorts of 6 physicians commencing training in a 3-month period; total of 4 clusters in the 1-year intervention period) will be assigned to one of two types of training (information structuring skills vs. emotion-handling skills). The primary outcome of the study will be patients' recall of information as a function of physician's training. For this purpose, we aim to recruit 50 patients presenting to the emergency department with chest pain in each 3-month period (N = 200, in the 1-year study period) and document the respective discharge communication (via audio recordings). In addition, each patient will be asked to recall the discharge information immediately after the discharge event, and, in a telephone interview, 7 days later (, telephone interview), as well as complete a number of other measures to assess secondary outcomes, such as overall satisfaction, and adherence to recommendations. The study will be conducted at the emergency department of the University Hospital of Basel (Switzerland).1.4. SignificanceThe current proposal represents an effort to engage in interdisciplinary crosstalk, in particular, it aims to use established insights from psychological theory-the beneficial role of information structuring for memory performance and comprehension-to improve discharge communication and patient care in an emergency department setting.