Strengthening transitions in pediatric care

Children and families experience many transitions in care when they interact with the health care system. Transitions in care occur when a child moves between health care providers or when they move from one care setting to another. Poor transitions in care create serious patient safety, quality of care and health outcome concerns. This program of research will use a theory-based, mixed methods approach to identify and examine gaps in transitions in care for children and families in emergency practice settings. Over 87% of children who visit Canadian emergency departments are discharged home to their place of residence. Following discharge, many children and their caregivers are unable to list their diagnosis, recount the name and purpose of medications they received, outline the recommendations for care at home or know when to return to seek medical advice. There are no national guidelines or policies related to discharge communication in Canadian pediatric emergency departments. We will conduct a series of observational studies to examine discharge communication across a range of emergency practice settings and patient conditions. We will begin by conducting focus groups with parents and physicians and nurses across six Canadian emergency departments. We will then analyze video recordings of discharge communication between families and health care providers in a pediatric emergency department. Finally we will conduct follow up telephone interviews with parents after discharge from the emergency department. Results from these studies will be used to design interventions to improve transitions from the emergency department for children and families. Interventions will be further developed through feasibility testing before evaluation in a multicentre randomized control trial. Findings from the observational work will also inform recommendations for national policies and guidelines to support discharge communication.