Emergency Department OvercrowdingNCT07447674
ED Post-Discharge Digital Follow-Up: A Communication Comparison
A study testing Standard Telephone Follow-Up and Enhanced Digital Communication Strategy in people with Emergency Department Overcrowding, run by Hospital Israelita Albert Einstein.
Trial 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. Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Emergency Department Overcrowding
- What is being tested?
- Standard Telephone Follow-Up and Enhanced Digital Communication Strategy
- Type of treatment
- Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 466 participants
- Where
- No sites listed yet
- Study dates
- 1 May 2026to 31 Jul 2027
- Phase
- Interventional
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- 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.
Who cannot join
- 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.
Trial locations and contacts
No sites are listed yet. Contact the study team or a site near you to ask about taking part.
About this study
Official title: Comparison of Communication Strategies in Post-discharge Digital Reassessment of Patients Attended In-person in the Emergency Department. Back to Digital Study.
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
- Being tested
- Standard Telephone Follow-Up, Enhanced Digital Communication Strategy
- Keywords
- Communication Strategies, Post-Discharge Digital Reassessment, Emergency Care Unit, Telemedicine, Patient Follow-Up
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Standard Telephone Follow-UpBehavioural
- 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 StrategyBehavioural
- 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.
| Study group | Role | What they receive |
|---|---|---|
| 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. Receives: 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. Receives: Behavioral: Enhanced Digital Communication Strategy |
What is being measured
The primary outcome is the main question the study is designed to answer.
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.
Measured: Within 24 hours after laboratory result availability.
Secondary outcomes (1)
Patient Satisfaction with Digital Reassessment Process (QAS-Tele Questionnaire)
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).
Measured: Within 48 hours after telemedicine reassessment.
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted3 Mar 2026
- Study start1 May 2026 (estimated)
- Primary completion28 Feb 2027 (estimated)
- Study completion31 Jul 2027 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Emergency Department OvercrowdingStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Health services research
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Enrolment
- 466 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Hospital Israelita Albert Einstein
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07447674
- Sponsor's protocol ID
- 85585724.2.0000.0071
- Status last verified
- Feb 2026
- First submitted
- 26 Feb 2026
- Last updated
- 23 Mar 2026
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
Study at a glance
From the registry record, last updated by the sponsor on 23 Mar 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Comparison of Communication Strategies in Post-discharge Digital Reassessment of Patients Attended In-person in the Emergency Department. Back to Digital Study.
- ClinicalTrials.gov ID
- NCT07447674
- Acronym / sponsor ID
- 85585724.2.0000.0071
- Conditions
- Emergency Department Overcrowding
- Keywords
- Communication Strategies, Post-Discharge Digital Reassessment, Emergency Care Unit, Telemedicine, Patient Follow-Up
- Study type
- Interventional
- Recruitment status
- Not yet recruiting
- Enrolment
- 466 participants (estimated)
- Lead sponsor
- Hospital Israelita Albert EinsteinUniversity, hospital or other
- Study start
- 1 May 2026 (estimated)
- Primary completion
- 28 Feb 2027 (estimated)
- Study completion
- 31 Jul 2027 (estimated)
- First posted
- 3 Mar 2026 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
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.
Study design
- Primary purpose
- Health services research
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Standard Telephone Follow-Up | Other | Behavioral: Standard Telephone Follow-UpControl 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. |
| Enhanced Digital Communication Strategy | Active comparator | Behavioral: Enhanced Digital Communication StrategyParticipants 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. |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (7 listed)
- 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;
Key exclusion criteria (7 listed)
- 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;
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Standard Telephone Follow-Up1. 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. | Behavioural | Standard Telephone Follow-Up |
| Enhanced Digital Communication Strategy1. 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. | Behavioural | Enhanced Digital Communication Strategy |
Primary outcome
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.
1 secondary outcome
Patient Satisfaction with Digital Reassessment Process (QAS-Tele Questionnaire)
Time frame: Within 48 hours after telemedicine reassessment.
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 23 Mar 2026.
Related trials for Emergency Department Overcrowding
RecruitingObservational study
Digital Anticipatory Protocols at Triage to Improve ED Flow.
Length of Stay, Emergency Department Crowding
Active, not recruitingObservational study
A New Crowding Indicator in the Emergency Department
Emergency Department, Crowding
Recruiting
Impact of Point-of-care Lactate Testing as Triage Supplement on Patient Management Using Manchester Triage System
Triage, Emergency Department Triage
Not yet recruitingObservational study
FOllow-up of LOW-acuity Patients After REdirection From a Swiss Emergency Department Using an Electronic TRIage Application
Triage, Low Acuity Patients
RecruitingObservational study
Acutelines: a Large Data-/Biobank of Acute and Emergency Medicine
Acute Disease, Sepsis
Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
Questions about this trial
What is this clinical trial studying?
A study testing Standard Telephone Follow-Up and Enhanced Digital Communication Strategy in people with Emergency Department Overcrowding, run by Hospital Israelita Albert Einstein.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 7 inclusion and 7 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: opening soon, as of the sponsor's last update on 23 Mar 2026. Status can change between updates, so confirm with the study contact before making plans.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact Tarso Accorsi, MD, PhD (+55 11 2151 2773, taccorsi@einstein.br), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Time to Telemedicine Contact After Emergency Department Discharge (time frame: Within 24 hours after laboratory result availability.). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 23 Mar 2026.