<p> Video Discharge: Gastroenteritis Phone Questionnaire 3/19/2010 Attachment 12</p><p>1. Caregiver Name: ______Phone number: ______</p><p>2. Group: VIDEO or WRITTEN</p><p>3. Date of call: ______Time of call: ______Call Outcome: ______Date of call: ______Time of call: ______Call Outcome: ______Date of call: ______Time of call: ______Call Outcome: ______Date of call: ______Time of call: ______Call Outcome: ______Date of call: ______Time of call: ______Call Outcome: ______</p><p>Hello. My name is ______and I am calling from XXXXs Pediatric Emergency Department. May I please speak with caregiver’s name? Your child was recently seen in the ED and you were asked several educational questions. I am calling to ask you some follow-up questions. This will only take about 3 minutes. Can you answer these questions now? **</p><p>It is fine if you cannot answer some of the questions. We are looking at our educational method and not you individually.</p><p>1. Please tell me about gastroenteritis. (circle all that apply and write in other comments) It is an infection of the digestive tract It causes diarrhea It is caused by a virus It causes dehydration It causes vomiting Other (please list)______</p><p>2. What are the signs of dehydration that you could see in your child? (circle all that apply and write in other comments)</p><p>Dry lips and mouth Feeling and acting tired Dark or strong smelling pee/urine Other (please list) Less urination than normal</p><p>3. How do you prevent dehydration in your child? (circle all that apply and write in other comments)</p><p>Giving small amounts of liquid more often Providing small amounts of sport drink or Pedialyte</p><p>Encouraging the child to drink to prevent dehydration Other (please list)______</p><p>4. How long should you expect your child to have vomiting and diarrhea?</p><p>Expect it to last for 2-5 days Other (please list)</p><p>5. When should your child return to the ED or to their doctor?</p><p>If vomiting and diarrhea lasts for more than 5 days Belly pain that does not go away If your child becomes dehydrated Other (please list) Blood in the diarrhea</p><p>6. How helpful was the discharge information in improving your understanding of your child’s medical condition? (circle one)</p><p>Not at all helpful Slightly helpful Moderately helpful Very helpful Extremely helpful</p><p>7. How helpful do you think a short video explaining your child’s medical condition would be to take home? (circle one)</p><p>Not at all helpful Slightly helpful Moderately helpful Very helpful Extremely helpful</p><p>THANK YOU for your time. Do you have any questions?</p><p>** If there is no answer, please leave the following message. Hello. My name is ______and I am calling from XXXXs Pediatric Emergency Department. I am calling for caregiver’s name. Your child was recently seen in the ED and you were asked several educational questions. I am calling to ask Video Discharge: Gastroenteritis Phone Questionnaire 3/19/2010 Attachment 12 you some follow-up questions. This will only take about 3 minutes. Please call xxx–xxx-xxxx and ask for me. I will be here until ___ o’clock today. Thank you.</p>