Improving Knowledge Translation Upon Emergency Department Discharge
Condition: Otitis Media
MeSH terms: Otitis Media; Emergencies
Study type: Interventional
Phase: Phase 3

Summary: 
      The amount and speed of emergency department (ED) discharge instructions often make it
      difficult for patients/caregivers to know the final diagnosis and to remember instructions.
      We hypothesize that a video on ear infections and antibiotics' role in their management will
      facilitate caregiver understanding and will increase the likelihood of caregivers properly
      following discharge instructions.

      To verify this hypothesis, a large multi-centre clinical trial is needed. Prior to this, it
      is only ethical to conduct a smaller 'pilot' trial. Previously healthy children (6 months-5
      years) diagnosed with mild ear infections at the McMaster Children's Hospital ED will be
      eligible to participate. If the child and caregiver decide to participate, before discharge,
      the caregiver will either: 1)watch the aforementioned video, 2)be given a pamphlet with the
      same information, or 3)standard of care (no additional information). Participants will fill a
      knowledge survey before discharge. The research assistant will contact all participants by
      phone to determine if the caregiver followed the discharge instructions.
    

Detailed description: 
      As most acute otitis media cases self-resolve, observation as initial management for mild
      acute otitis media (AOM) is recommended by Canadian and American authorities. However, North
      American children receive more antibiotics for AOM than for any other reason, making
      AOM-related prescribing a key focus for antimicrobial stewardship interventions. Low uptake
      of the ED suggested management strategies may be caused by caregiver under-appreciation of
      antibiotic-associated harms or from problems understanding the discharge plan, of which both
      could be remedied by a novel video-based knowledge translation platform.

      The aim of this pilot study is to determine the feasibility of a follow-up large trial. The
      main clinical research question is: for caregivers of previously healthy children aged 6-59
      months who are diagnosed by the ED physician with acute otitis media and judged to be
      eligible for a watchful waiting approach, will the use of an innovative informative video
      lead to lower rates of unnecessary antibiotic use as compared to a pamphlet or no
      intervention (reference standard)?

      This will be a single-centre, randomized, controlled, pilot trial. Caregivers of previously
      well children aged 6-59 months presenting to the McMaster Children's Hospital (MCH) ED with
      non-severe AOM eligible for a watchful waiting approach will be enrolled and randomized to a
      video intervention, a pamphlet intervention, or standard care (no intervention). The primary
      outcome is the proportion of caregivers who fill a prescription for antimicrobials <48 hours
      after recruitment, as caregivers are generally advised to wait 48-72 hours prior to
      administering antibiotics to healthy children with mild AOM.
    

Intervention name(s): Video; Pamphlet
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Animated video explaining acute otitis media and antimicrobial stewardship.; Contains same information as video.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: knowledge translation; antimicrobial stewardship