ED Post-Discharge Digital Follow-Up: A Communication Comparison

NCT07447674 | Not Yet Recruiting

• 1 other identifier: 85585724.2.0000.0071
• Study Type: interventional
• Target: 466
• Locations: 0 countries
• Sites: N/A

Brief 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.

Conditions

Emergency Department Overcrowding

Keywords

Communication Strategies; Post-Discharge Digital Reassessment; Emergency Care Unit; Telemedicine; Patient Follow-Up

Outcome Measures

Primary Outcomes (1)

• Time to Telemedicine Contact After Emergency Department Discharge

  Time elapsed (in minutes) between documentation of medical discharge in the electronic health record of the Emergency Care Unit and the moment of patient contact with the telemedicine team, while in possession of laboratory test results.

  Within 24 hours after laboratory result availability.

Secondary Outcomes (1)

• Patient Satisfaction with Digital Reassessment Process (QAS-Tele Questionnaire)

  Within 48 hours after telemedicine reassessment.

Study Arms (2)

Standard Telephone Follow-Up

OTHER

Control arm - Participants randomized to the Standard Telephone Follow-Up arm will be registered in the telemedicine system by the nursing team after administrative discharge from the Emergency Care Unit. The telemedicine nurses will periodically monitor the results of the requested laboratory tests. Immediately after laboratory results become available, the nursing team will attempt telephone contact with the patient to provide reassessment and guidance. If the initial call attempt is unsuccessful, a second attempt will be made after 2 hours, according to the institutional standard protocol.

Behavioral: Standard Telephone Follow-Up

Enhanced Digital Communication Strategy

ACTIVE COMPARATOR

Participants randomized to the Enhanced Digital Communication Strategy arm will receive, prior to discharge, instructions to independently check their laboratory results through the "Meu Einstein" application and to contact HIAE within a maximum of one hour after results become available. Immediately upon release of laboratory results, patients will receive a WhatsApp message and an email reinforcing the instruction to initiate contact with HIAE. If no patient-initiated contact occurs within 1 hour after result availability and message delivery, the telemedicine nursing team will proceed with telephone contact according to the standard protocol. If the call attempt is unsuccessful, a second attempt will be made after 2 hours.

Behavioral: Enhanced Digital Communication Strategy

Interventions

Standard Telephone Follow-Up BEHAVIORAL

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.

Standard Telephone Follow-Up

Enhanced Digital Communication Strategy BEHAVIORAL

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.

Enhanced Digital Communication Strategy

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Age ≥ 18 years;
• Initial in-person evaluation at the Emergency Care Unit of Hospital Israelita Albert Einstein;
• Emergency Severity Index (ESI) classification of 3, 4, or 5 during nursing triage;
• In-person medical evaluation confirming low-risk classification;
• Request for complementary laboratory tests;
• Acceptance of digital reassessment after discharge;
• Provision of written informed consent.

You may not qualify if:

• Request for blood culture testing;
• Request for imaging studies (except chest X-ray evaluated in the Emergency Care Unit prior to discharge);
• Laboratory tests with an expected turnaround time greater than 24 hours;
• Change in clinical complexity level after medical evaluation;
• Failure to transfer the discharged patient's identification to the Telemedicine Center;
• Activation of a scheduled contingency plan at external units preventing timely patient registration in the telemedicine system as required by the program;
• Lack of access to a smartphone with WhatsApp and email for communication.

Sponsors & Collaborators

• Hospital Israelita Albert Einstein: lead

Central Study Contacts

Tarso Accorsi, MD, PhD

CONTACT

+55 11 2151 2773; taccorsi@einstein.br

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: February 26, 2026
• First Posted: March 3, 2026
• Study Start: May 1, 2026
• Primary Completion (Estimated): February 28, 2027
• Study Completion (Estimated): July 31, 2027
• Last Updated: March 23, 2026

Record last verified: 2026-02