De l'innovation au changement - Gouvernement du Québec

4. PROCESSUS DE MISE EN ŒUVRE
Projet 16
Impact of a discharge coordinator on the sucessful discharge
of elderly patients from the emergency department (ED),région de Montréal
Impact d’un coordonnateur des congés au département d’urgence (DU)
sur le succès du congé des patients âgés
emergency department, hospital and community health services 3) improving the communication between the emergency and community
health care providers.
Research question : What is the impact a dedicated discharge planner in the ED on elderly patients discharged from the ED in terms of:
ED return visits and hospitalisations within 14 days of discharge, satisfaction with discharge, compliance with discharge instructions, and
perception of well being
4.1 Modalités de mise en oeuvre The nursing intervention, delivered by a discharge nurse dedicated to the elderly, was structured, in this project, to include patient
education, coordination of referrals and appointments, telephone follow up and telephone access to the nurse discharge coordinator within
7 days of discharge. Although formalised, the intervention was individualised to the needs of each patient and family. In order to be
effective, three nurses were hired to be able to cover evenings and weekends, periods that were traditionally vulnerable to “patients falling
through the cracks”.
A large emphasis was placed on medication management – assistance to acquire medications, and the understanding of administration of
new medications.
Emphasis was placed on assistance with acute pain management – mostly in the use of narcotic and non-narcotic analgesia. Other
symptom management teaching often related to the degree to which the patient seemed interested.
Practical strategies for creating a learning environment most often included the inclusion of family members.
4.2 Enjeux ou défis posés par
l’innovation
Aucune information à ce sujet.
4.3 Conditions favorables ou facilitantes Factors that affected learning were most often related to the length of time patients waited to be seen and have diagnostic test results. This
was found to impede learning. Patient fatigue impeded their ability to absorb information. Reinforcement of information was often
conducted over the telephone. Involvement of family members in the learning process also strengthened the retention of new information.
Emergency physicians identified and expressed a broader ‘comfort level’ in discharging higher risk patients with the knowledge that they
would be followed by the nurse discharge coordinator. As a consequence, medically unnecessary overnight stays in the ED were at times
avoided.
A priority telephone line between the hospital and the CLSC’s, created as a direct result of the study, facilitated the response time to the
CLSC intake service. Future goals include development of a system to quickly identify patients in the ED who are regular uses of
community home care services “guichet unique”, and as such, considered the most frail.
4.4 Obstacles It is clear that the intervention group was more frail and therefore perhaps at higher overall risk of return. These differences in the group
health characteristics can be explained as follows. In the control phase, patients were asked to consent to an interview in the ED and over
the telephone. They were not provided with any care or compensation. Therefore, those patients who were more functionally frail or
perceived their illness as being very severe, tended to refuse participation stating that they were too sick to participate.
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