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

Published online by Cambridge University Press:  11 February 2015

Sylvie Cossette ,
Alain Vadeboncoeur ,
Nancy Frasure-Smith ,
Jane McCusker ,
Danielle Perreault  and
Marie-Claude Guertin
Sylvie Cossette*
Affiliation:
Faculty of Nursing, University of Montreal, and Montreal Heart Institute Research Center
Alain Vadeboncoeur
Affiliation:
Emergency Department, Montreal Heart Institute
Nancy Frasure-Smith
Affiliation:
Faculty of Psychiatry and Nursing, McGill University, and Centre hospitalier de l'Université de Montréal, and Montreal Heart Institute Research Center
Jane McCusker
Affiliation:
Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, and St. Mary's Research Centre
Danielle Perreault
Affiliation:
Emergency Department, Montreal Heart Institute
Marie-Claude Guertin
Affiliation:
Department of Biostatistics, Montreal Health Innovations Coordinating Center, Montreal, QC
*
Correspondence to: Dr. Sylvie Cossette, University of Montreal, Montreal Heart Institute Research Center, S-2510, 5000, Bélanger est, Montreal, QC H1T 1C8; [email protected].

Abstract

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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.

Résumé

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.

Keywords

cardiac diseasesemergency departmentnursing interventionrandomized controlled trial
Type
Original Research
Information
Canadian Journal of Emergency Medicine , Volume 17 , Issue 1 , January 2015 , pp. 13 - 20
Copyright
Copyright © Canadian Association of Emergency Physicians 2014 

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