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NCT Number: NCT07447674

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

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.

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Key information

Conditions

Emergency Department Overcrowding

Age range

18 year and older

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • 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.

Exclusion criteria

  • 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.

Treatment and study plan

Standard Telephone Follow-Up

Behavioral
  • The telemedicine nursing team registers the patient in the telemedicine system and periodically checks the results of the requested laboratory tests.
  • A telephone call is made immediately after laboratory results become available.
  • If the initial call is unsuccessful, a second attempt is made after 2 hours.

Enhanced Digital Communication Strategy

Behavioral
  • 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.
  • Immediately after laboratory results become available, a WhatsApp message and an email are sent to the patient with instructions to contact HIAE.
  • 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.
  • If the call is unsuccessful, a second attempt is made after 2 hours.

Primary outcomes

  1. Time to Telemedicine Contact After Emergency Department Discharge

    Time frame: Within 24 hours after laboratory result availability.

    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.

Secondary outcomes

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

    Time frame: Within 48 hours after telemedicine reassessment.

    Patient-reported satisfaction measured using the validated QAS-Tele questionnaire (adapted version including nursing participation in items 7, 10, 11, and 12). The survey link will be sent via WhatsApp and/or email. The questionnaire consists of items rated on a Likert scale ranging from 1 (lowest satisfaction) to 5 (highest satisfaction). Total scores are calculated by summing item responses, with higher scores indicating greater patient satisfaction (better outcome).

Study contacts

Contact information is provided by the study sponsor or research team.

Tarso Accorsi, MD, PhD

CONTACT

[email protected]

+55 11 2151 2773

Sponsors and collaborators

Lead sponsor

Hospital Israelita Albert Einstein

Other

Registry information

Official study title

Comparison of Communication Strategies in Post-discharge Digital Reassessment of Patients Attended In-person in the Emergency Department. Back to Digital Study.

Important dates

Study start
2026
Primary completion
2027
Study completion
2027
First posted
Mar 3, 2026
Registry last updated
Mar 23, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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