De l'innovation au changement - Gouvernement du Québec

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
In the intervention phase, however, patients consented not only to the study interview but also to being seen by a nurse who would assist
them with their discharge care and on whom they could call upon over a 7 day period post discharge. Those patients who were less frail,
were now more likely to refuse participation stating that they did not need to see a nurse or their problem was not so severe as to warrant a
nursing intervention. Those patients who were more frail were now more likely to participate because they were now being offered the
benefits of extra nursing services.
5. BILAN DE L’EXPÉRIMENTATION
5.1 Résultats Patient Characteristics: There were no significant differences between the groups with respect to mean age (82 years), gender, marital
status, ability to speak English or French, or in level of education and income. But several differences were noted in patient health
characteristics between groups. The patients in the intervention group reported significantly more heart disease (43% vs 38%), diabetes
(19% vs 15%), and mobility problems (14% vs 10%). They exhibited a higher complexity medication score (20.8 vs 17) and were less
functionally autonomous (51% vs 59%). In the area of social support, the intervention group reported less availability of a caregiver (34%
vs 23%) and more social impairment (31% vs 21%).
Unscheduled return : A difference in unscheduled revisits to the ED between the control and intervention phase was demonstrated at both
8 and 14 days post discharge. Unscheduled revisits were decreased by 27 % at Day 8 (8.5% vs 11.6%) and by 19% (12.9% vs 16.1%) at
Day 14. This translated into a statistically significant odds ratio for revisits of 0.71 at Day 8. Although the odds ratio of 0.78 at day 14 did
not reach statistical significance, the 95% confidence intervals demonstrate that there is potentially a clinically significant decrease in return
visits even at 14 days. The absolute risk reduction of 3.1% seen at Day 8 is maintained at Day 14 reflecting our belief that the major impact
of the discharge planner would be seen in the first week ie. during the period of nursing intervention and that this impact was carried
forward.
A significant difference was found in the perceived severity of presenting illness and baseline functional autonomy between the two groups.
Patients in the intervention phase had a higher perception of severity of illness at presentation and had a lower level of functional
autonomy.
Unscheduled hospital admissions : The absolute number of unscheduled hospital admissions within 14 days of ED discharge is small in
both the control (47) and intervention (39) groups. Hence, no significant conclusions can be drawn with respect to the influence a
discharge planner may have on hospital admissions.
Health and Welfare of the Target Population : Our study was of too short a time interval (2 week assessment) to have a major impact on
general health indicators. However, a few points are worth noting. The population studied, by nature of their age, is at a high risk for
morbidity. Nevertheless, the intervention group seems to have a positive benefit, in that, fewer of these patients revisited the ED during the
study period, were more compliant with their medications and generally felt better by one week.
Compliance with medication : Overall, compliance to new medications was high in both groups with a slight favouring of the intervention
group (96.8% vs 92.8%)
Well being: One of the basic questions in clinical studies is whether the intervention has resulted in a patient who feels better. We
addressed this by simply asking the patients to rate how they felt at day 8 compared to the day of discharge. We found that 64.5% vs
58.8% felt better in the intervention group (absolute difference 5.8%, 95%CI 0.4-11.9%). This translated to an odds of improvement of 1.3
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