Anticipatory Guidance in the Nursery and Its Impact on Non-urgent Emergency Department Visits

Study Overview
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Brief Summary
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Kennedy et al, in a study of pediatric Emergency Department (ED) use by newborns less than 14 days of age, revealed that half of all visits in this population were non-acute problems. Other pediatric ED utilization studies have shown similar findings in that 32% to 72% of all visits were for non-urgent problems. Many studies have found that primiparity and young maternal age are associated with non-acute ED presentations. A recent factor that has been investigated is the effect of early neonatal discharge. Some other factors are nonwhite mothers and mothers on Medicaid. Zandieh et al, found additional predisposing determinants for non-urgent ED visits, such as single parenthood, Hispanic ethnicity, and having perceptions that their child's overall physical health was poor. Paradis et al found that parents receiving a video intervention rated higher confidence with specific infant care skills and reported feeling better prepared to care for their baby, compared to parents receiving only handouts. However, there isn't any reported study that evaluates the benefits of receiving both, a video intervention along with handouts. Aim: to demonstrate whether conducting anticipatory guidance related to non-urgent problems will reduce non-urgent ED visits, compared to care as usual (CAU) anticipatory guidance (Sudden Infant Death Syndrome and Shaken Baby Syndrome videos; and unstructured talk about jaundice, vaccinations, appointments, care of umbilical stump, normal urination and bowel movement, fever).

Detailed Description
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Inclusion Criteria: Mother of a newborn in the Well Baby Nursery (WBN) of Bronx-Lebanon Hospital Center during the 4-month recruitment period of the study. Exclusion Criteria: Mothers selected for video-based anticipatory guidance that have a hearing/vision impairment. Mothers selected for handout-based anticipatory guidance who speak a language other than Spanish or English. Primary outcome measure: reduction in non-urgent ED visits in mothers who received the intervention (video-based and handout-based anticipatory guidance regarding non-urgent problems), compared to the control group (received CAU anticipatory guidance) Secondary outcome measure: improvement in parental knowledge, attitude and behaviors related to non-urgent problems as a result of receiving anticipatory guidance (video and handouts) regarding non-urgent problems;

Official Title
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Anticipatory Guidance in the Nursery and Its Impact on Non-urgent Emergency Department Visits

Conditions
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Health Knowledge, Attitudes, Practice, Sneezing, Constipation, Nasal Congestion and Inflammations

Intervention / Treatment
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* Behavioral: Intensified anticipatory guidance
* Behavioral: Routine


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Mother of a newborn in the WBN of Bronx-Lebanon Hospital Center during the 4-month recruitment period of the study Exclusion Criteria: Mothers selected for video-based anticipatory guidance that have a hearing/vision impairment. Mothers selected for handout-based anticipatory guidance who speak a language other than Spanish or English.
Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Placebo Comparator: Control<br>Mothers receive routine anticipatory guidance | Behavioral: Routine<br>* Routine anticipatory guidance (control)<br>|
| Experimental: Intervention<br>Mothers receive video-based and handout-based anticipatory guidance regarding non-urgent problems in addition to the routine anticipatory guidance | Behavioral: Intensified anticipatory guidance<br>* Mothers receive video-based and handout-based anticipatory guidance regarding non-urgent problems in addition to the routine anticipatory guidance<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Non-urgent ED visits by neonates | Reduction in non-urgent ED visits in mothers who received the intervention (video-based and handout-based anticipatory guidance regarding non-urgent problems), compared to the control group (received CAU anticipatory guidance) | 1 month | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Changes in caregivers' knowledge and attitude | Improvement in parental knowledge, attitude and behaviors related to non-urgent problems as a result of receiving anticipatory guidance (video and handouts) regarding non-urgent problems | 1 month | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Non-urgent ED visits, Neonates, Newborn care