Telephone follow-up to reduce unplanned hospital returns for older emergency department patients: A randomized trial

被引:11
|
作者
Van Loon-van Gaalen, Merel [1 ]
van der Linden, M. Christien [1 ]
Gussekloo, Jacobijn [2 ,3 ]
van der Mast, Roos C. [4 ,5 ]
机构
[1] Haaglanden Med Ctr, Emergency Dept, POB 432, NL-2501 CK The Hague, Netherlands
[2] Leiden Univ, Dept Internal Med, Sect Gerontol & Geriatr, Med Ctr, Leiden, Netherlands
[3] Leiden Univ, Dept Publ Hlth & Primary Care, Med Ctr, Leiden, Netherlands
[4] Leiden Univ, Dept Psychiat, Med Ctr, Leiden, Netherlands
[5] CAPRI Univ Antwerp, Dept Psychiat, Antwerp, Belgium
关键词
emergency department; geriatric; older patients; post-discharge follow-up; telephone; DISCHARGE INSTRUCTIONS; ELDERLY-PATIENTS; CARE; ADULTS; ADMISSION; VISITS; CALLS; RISK; COMPREHENSION; PATTERNS;
D O I
10.1111/jgs.17336
中图分类号
R592 [老年病学]; C [社会科学总论];
学科分类号
03 ; 0303 ; 100203 ;
摘要
Background/Objectives Telephone follow-up calls could optimize the transition from the emergency department (ED) to home for older patients. However, the effects on hospital return rates are not clear. We investigated whether telephone follow-up reduces unplanned hospitalizations and/or unplanned ED return visits within 30 days of ED discharge. Design Pragmatic randomized controlled trial with allocation by month; odd months intervention group, even months control group. Setting Two ED locations of a non-academic teaching hospital in The Netherlands. Participants Community-dwelling adults aged >= 70 years, discharged home from the ED were randomized to the intervention group (N = 4732) or control group (N = 5104). Intervention Intervention group patients: semi-scripted telephone call from an ED nurse within 24 h after discharge to identify post-discharge problems and review discharge instructions. Control group patients: scripted satisfaction survey telephone call. Measurements Primary outcome: total number of unplanned hospitalizations and/or ED return visits within 30 days of ED discharge. Secondary outcomes: separate numbers of unplanned hospitalizations and ED return visits. Subgroup analysis by age, sex, living condition, and degree of crowding in the ED at discharge. Results Overall, 42% were males, and median age was 78 years. In the intervention group, 1516 of 4732 patients (32%) consented, and in the control group 1659 of 5104 (33%) patients. Unplanned 30-day hospitalization and/or ED return visit was found in 16% of intervention group patients and 14% of control group patients (odds ratio 1.16; 95% confidence interval: 0.96-1.42). Also, no statistically significant differences were found in secondary outcome measures. Within the subgroups, the intervention did not have beneficial effects for the intervention group. Conclusion Telephone follow-up after ED discharge in older patients did not result in reduction of unplanned hospital admissions and/or ED return visits within 30 days. These results raise the question of whether other outcomes could be improved by post-discharge ED telephone follow-up.
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页码:3157 / 3166
页数:10
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