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ED Post-Discharge Digital Follow-Up: A Communication Comparison
Sponsor: Hospital Israelita Albert Einstein
Summary
Emergency department overcrowding is a universal phenomenon associated with worse patient outcomes and a negative impact on healthcare teams. Telemedicine has been routinely implemented as a strategy to mitigate the harmful effects of overcrowding, particularly in pre-hospital assessments and triage processes. Since April 2024, the Emergency Care Units of Hospital Israelita Albert Einstein (HIAE) have offered low-risk patients-after nursing triage and in-person medical evaluation-the option of administrative discharge followed by digital reassessment via telemedicine. Currently, the initial communication strategy consists of an audio telephone call conducted by the telemedicine nursing team. In this study, we aim to test the hypothesis that the addition of alternative communication strategies may be associated with improved outcomes. This prospective, single-center, randomized, open-label pilot study will be conducted at a telemedicine center that serves five Emergency Care Units of HIAE. The study population will include patients aged 18 years or older who spontaneously seek care at an Emergency Care Unit, are classified as ESI 3, 4, or 5 during nursing triage, undergo in-person medical evaluation confirming low-risk status, and have complementary laboratory tests requested. Patients will be excluded if imaging exams are requested, if laboratory tests are expected to have a turnaround time exceeding 24 hours, or if they do not have access to a smartphone with WhatsApp and email for communication. After administrative discharge from the Emergency Department, patients will be randomized to one of two communication strategies: standard care, consisting of telephone contact by the telemedicine nursing team, or an incremental strategy, which includes instructions to check laboratory results via an application, reminder messages prompting patient-initiated contact through WhatsApp and email, and a telephone call in cases where no spontaneous contact occurs. The primary endpoint will be the time elapsed between medical discharge from the Emergency Care Unit and patient contact with HIAE.
Official title: Comparison of Communication Strategies in Post-discharge Digital Reassessment of Patients Attended In-person in the Emergency Department. Back to Digital Study.
Key Details
Gender
All
Age Range
18 Years - Any
Study Type
INTERVENTIONAL
Enrollment
466
Start Date
2026-05-01
Completion Date
2027-07-31
Last Updated
2026-03-23
Healthy Volunteers
No
Conditions
Interventions
Standard Telephone Follow-Up
1. The telemedicine nursing team registers the patient in the telemedicine system and periodically checks the results of the requested laboratory tests. 2. A telephone call is made immediately after laboratory results become available. 3. If the initial call is unsuccessful, a second attempt is made after 2 hours.
Enhanced Digital Communication Strategy
1. Prior to discharge, patients are instructed to check their test results independently (via the "Meu Einstein" app) and to contact HIAE within a maximum of one hour after laboratory results become available. 2. Immediately after laboratory results become available, a WhatsApp message and an email are sent to the patient with instructions to contact HIAE. 3. An audio phone call is performed according to the standard protocol if no patient response occurs within 1 hour after results become available and the message has been sent. 4. If the call is unsuccessful, a second attempt is made after 2 hours.