Skip to main content Accessibility help
×
Home

Randomized controlled trial of a nursing intervention to reduce emergency department revisits

  • Sylvie Cossette (a1), Alain Vadeboncoeur (a2), Nancy Frasure-Smith (a3), Jane McCusker (a4), Danielle Perreault (a2) and Marie-Claude Guertin (a5)...

Abstract

Objective

To determine whether a nursing intervention delivered at emergency department (ED) discharge would reduce ED revisits.

Method

A randomized study was conducted in the ED of a tertiary cardiac hospital in Montreal, Quebec. Between November 2006 and March 2010, 3,795 patients were assessed for eligibility based on two risk factors for ED revisits (≥1 ED visit in the past year and ≥6 medications); 132 were randomized to the experimental group (EG) and 133 to the control group (CG). The intervention included one nurse-patient meeting before leaving the ED, with two additional telephone contacts over the next 2 weeks. The primary outcome was time to ED revisits within 30 days after discharge. Secondary outcomes included time to ED revisits over 90, 180, and 365 days and hospitalizations over 30, 90, 180, and 365 days.

Results

A planned interim analysis that stopped the study with half of the planned sample showed that the time to ED revisits was similar in both groups at 30 days (p=0.81; revisits: 18.2% in EG, 19.6% in CG), 90 days (p=0.44), 180 days (p=0.98), and 365 days (p=0.75). The only difference identified was a lower hospitalization proportion at 180 days in the EG group (13.6% v. 24.1%; p=0.038).

Conclusions

These findings are consistent with previous research showing that few ED-based interventions are successful in reducing ED returns. Factors other than those targeted by the intervention, including an improvement in usual care, may explain the findings.

Objectif

L’étude visait à déterminer si une intervention en soins infirmiers, appliquée au moment du congé du service des urgences (SU) permettrait de réduire le nombre de reconsultations à ce même service.

Méthode

Une étude à répartition aléatoire a été menée au SU d’un hôpital de soins tertiaires en cardiologie, à Montréal. De novembre 2006 à mars 2010, 3795 patients ont été évalués au regard de l’admissibilité à l’étude, et ce, d’après deux facteurs de risque de reconsultation au SU (≥ 1 consultation au SU au cours de la dernière année et ≥ 6 médicaments); 132 sujets ont été dirigés au hasard vers le groupe expérimental (GE) et 133 vers le groupe témoin (GT). L’intervention consistait en un entretien personnel entre le patient et l’infirmière avant le départ du SU et en deux appels téléphoniques de suivi au cours des 2 semaines suivantes. Le principal critère d’évaluation était le temps écoulé avant une reconsultation au SU au cours des 30 jours suivant le congé. Les critères secondaires d’évaluation comprenaient le temps écoulé avant une reconsultation au SU au cours des 90, 180, et 365 jours et avant une hospitalisation au cours des 30, 90, 180, et 365 jours.

Résultats

Une analyse intermédiaire planifiée a révélé que le temps écoulé avant une reconsultation au SU était comparable dans les deux groupes au bout de 30 jours (p=0.81; reconsultations: 18.2% dans le GE contre [c.] 19.6% dans le GT), de 90 jours (p=0.44), de 180 jours (p=0.98), et de 365 jours (p=0.75), ce qui a mis fin à l’étude, au moment où la moitié de la taille prévue de l’échantillon avait été atteinte. La seule différence observée était une diminution de la proportion des hospitalisations au bout de 180 jours dans le GE (13.6% v. 24.1%; p=0.038).

Conclusions

Les résultats vont dans le même sens que ceux d’autres études, selon lesquels peu d’interventions réalisées au SU permettent de réduire le nombre de reconsultations à ce même service. Des facteurs différents de ceux ciblés par l’intervention, notamment unes amélioration des soins courants, pourraient expliquer ces résultats.

    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Randomized controlled trial of a nursing intervention to reduce emergency department revisits
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Randomized controlled trial of a nursing intervention to reduce emergency department revisits
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Randomized controlled trial of a nursing intervention to reduce emergency department revisits
      Available formats
      ×

Copyright

Corresponding author

Correspondence to: Dr. Sylvie Cossette, University of Montreal, Montreal Heart Institute Research Center, S-2510, 5000, Bélanger est, Montreal, QC H1T 1C8; Sylvie.cossette.inf@umontreal.ca.

References

Hide All
1.Understanding emergency department wait times. III. Who is using emergency department and how long are they waiting?. Ottawa (ON)Canadian Institute of Health Information; 2005.
2.Gagnon, A, Schein, C, McVey, LN, et al. Randomized controlled trial of nurse case management of frail older people. J Am Geriatr Soc 1999;47:11181124.
3.McCusker, J, Jacobs, P, Dendukuri, N, et al. Cost-effectiveness of a brief two-stage emergency department intervention for high-risk elders: results ofa quasi-randomized controlled trial. Ann EmergMed 2003;41:4556, doi:10.1067/mem.2003.4.
4.Shumway, M, Boccellari, A, O’Brien, K, et al. Cost-effectiveness of clinical case management for ED frequent users: results of a randomized trial. AmJEmerg Med 2008;26:155164, doi:10.1016/j.ajem.2007.04.021.
5.Hansagi, H, Olsson, M, Hussain, A, et al. Is information sharing between the emergency department and primary care useful to the care of frequent emergency department users? EurJEmerg Med 2008;15:3439, doi:10.1097/MEJ.0b013e3282aa4115.
6.Spillane, LL, Lumb, EW, Cobaugh, DJ, et al. Frequent users of the emergencydepartment: can we intervene? AcadEmergMed 1997;4:574580, doi:10.1111/j.1553-2712.1997.tb03581.x.
7.Caplan, GA, Williams, AJ, Daly, B, et al. A randomized, controlled trial of comprehensive geriatric assessment and multidisciplinary intervention after discharge of elderly from the emergency department--the DEED II study. JAm Geriatr Soc 2004;52:14171423, doi:10.1111/j.1532-5415.2004. 52401.x.
8.Mion, LC, Palmer, RM, Meldon, SW. Case finding and referral model for emergency department elders: a randomized clnical trial. Ann Emerg Med 2003;41:5768, doi:10. 1067/mem.2003.3.
9.Current Controlled Trials. Available at: www.controlled-trials.com (accessed April 19, 2013).
10.Zwarenstein, M, Treweek, S, Gagnier, JJ, et al. Improving the reporting of pragmatic trials: an extension of the CONSORT statement. BMJ 2008;337(a2390):18, doi:10.1136/bmj.a2390.
11.The Consort Group. The Consort Statement. Available at: http://www.consort-statement.org/ (accessed April 19, 2013).
12.Vadeboncoeur, A, Kennedy, W, Bourdages, T, et al. Risk factor predicting return to the emergency department by patients usingthe emergency department of the Montreal Heart Institute. Poster presentation at the 2nd Mediterranean Emergency Medicine Congress 2003; Barcelona, Spain. Available at: http://www.emcongress.org/barcelona03/ (accessed August 5, 2013).
13.Ashton, CM, Wray, NP. A conceptual framework for the study of early readmission as an indicator of quality of care. Soc Sci Med 1996;43:15331541, doi:10.1016/S0277-9536(96) 00049-4.
14.Heppell, S, Cossette, S, Vadeboncoeur, A, et al. Exploration of needs for follow-up among patients after an emergency department visit: a focus group investigation [Identification des besoins de suivi chez des patients qui se presentent dans une urgence cardiologique: resultats d'un focus groupe]. Can J Cardiovasc Nurs 2005;15(1):50.
15.Cossette, S, Frasure-Smith, N, Lesperance, F. Clinical implications of a reduction in psychological distress on cardiac prognosis in patients participating in a psychosocial intervention program. Psychosom Med 2001;63:257266.
16.Frasure-Smith, N, Lesperance, F, Prince, RH, et al. Randomised trial of home-based psychosocial nursing intervention for patients recovering from myocardial infarction. Lancet 1997;350:473479, doi:10.1016/S0140-6736(97)02142-9.
17.Hegney, D, Buikstra, E, Chamberlain, C, et al. Nurse discharge planning in the emergency department: a Toowoomba, Australia, study. JClin Nurs 2006;15:10331044, doi:10.1111/j.1365-2702.2006.01405.x.
18.Miller, DK, Lewis, LM, Nork, MJ, et al. Controlled trial of a geriatric case-finding and liaison service in an emergency department. J Am Geriatr Soc 1996;44:513520.
19.Andren, KG, Rosenqvist, U. Heavy users of an emergency department: psycho-social and medical characteristics, other health care contacts and the effect of a hospital social worker intervention. Soc Sci Med 1985;21:761770, doi:10.1016/0277-9536(85)90124-8.
20.Okin, RL, Boccellari, A, Azocar, F, et al. The effects of clinical case management on hospital service use among ED frequent users. Am J Emerg Med 2000;18:603608, doi:10. 1053/ajem.2000.9292.
21.Guttman, A, Afilalo, M, Guttman, R, et al. An emergency department-based nurse discharge coordinator for elder patients: does it make a difference? AcadEmergMed 2004;11:13181327, doi:10.1197/j.aem.2004.07.006.
22.Moher, D, Hopewell, S, Schulz, KF, et al. CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials. JClin Epidemiol 2010;63(8):e1e37, doi:10.1016/j.jclinepi.2010.03.004.
23.McCusker, JM, Ionescu-Ittu, R, Ciampi, A, et al. Hospital characteristics and emergency department care of older patients are associated with return visits. Acad Emerg Med 2007;14:426432.
24.Clarke, A. Are readmissions avoidable? BMJ 2004;301:11361138, doi:10.1136/bmj.301.6761.1136.
25.Cardin, S, Afilalo, M, Lang, E, et al. Intervention to decrease emergency department crowding: does it have an effect on return visits and hospital readmissions. Ann Emerg Med 2003;41:173185, doi:10.1067/mem.2003.50.
26.Snapinn, S, Chen, M-G, Jiang, Q, et al. Assessment of futility in clinical trials. Pharm Stat 2006;5:273281, doi:10.1002/ pst.216.

Keywords

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed