Electronic Discharge Communication Tools Used in Pediatric Emergency Departments: Systematic Review

Electronic discharge communication tools (EDCTs) are now increasingly common in pediatric EDs. These tools have shown to improve patient-centered communication, support post-discharge care at home, and reduce unnecessary return visits to the emergency department (ED). To map and assess the evidence-base for EDCTs used in pediatric EDs according to their functionalities, intended purpose, implementation context features and purported outcomes. A systematic review was conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) procedures for identification, screening, and eligibility. Seven databases (EBSCO, MEDLINE,CINAHL PsycINFO; EMBASE, SCOPUS and Web of Science PsycINFO) were searched for studies published between 1989-2021. Studies evaluating discharge communication related outcomes using electronic tools (e.g., text messages, videos, web-based platforms, kiosks) in pediatric EDs were included. Two researchers independently assessed eligibility. Data extraction variables related to study identification, methodology, settings and demographics, intervention design features, outcomes implementation features and practice, policy and research implications. The Mixed Method Appraisal Tool (MMAT) was used to assess methodological quality across study designs. Synthesis of results involved structured tabulation, vote counting, recoding into common metrics, inductive thematic analysis, descriptive statistics and heat mapping. In total, 231 full-text articles and abstracts were screened for review inclusion with 49 reports (representing 55 unique tools) included. Seventy percent of studies met at least three of five MMAT criteria. The most common EDCTs were videos, text messages, kiosks, and phone calls. Time required to use the tools ranged from 120 seconds to 80 minutes. The EDCTs were evaluated for numerous presenting conditions (e.g., asthma, fracture, head injury, fever, otitis media) that required a range of at-home care needs after the ED visit. The most frequently measured outcomes were knowledge acquisition, caregiver and patient beliefs and attitudes, and health service utilization. Unvalidated, self-report measures were typically used for measurement. Health care provider satisfaction or system level impacts were infrequently measured in studies. Directionality of primary outcomes pointed to positive effects for the primary measure (80%, 44/55) or no significant difference (18%, 10/55). Only one study reported negat