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
(95%CI 1.03-1.56) when a discharge coordinator is involved.
Quality of Service: The study impacted the quality of discharge care offered to elderly patients and their families on several levels. To the
patient and family, the nursing intervention improved the comprehensiveness and clarity of discharge instructions. Patients in the
intervention group expressed a significantly higher level of satisfaction across all aspects of the discharge teaching as compared to usual
care.
Anticipatory guidance with respect to care at home and symptom management potentially avoided an unnecessary return visit.
Furthermore, for the first time, care of the patient who presented to the ED was extended beyond the hospital walls. The intervention model
created a system to address patient concerns, if any, after discharge. Follow up phone calls conducted by the discharge nurse provided
the bridge between the ED and community care. Patient and family concerns were addressed in a timely and efficient manner and
potential problems were detected early. Patients stated that they felt that they “mattered” and that “someone cared”.
Facilitating Integration/Coordination With Other Parts of the Health Care System : The major benefit of the intervention model was that it
identified and specified a structured nursing role for the coordination of discharge and integration of services. The link between the
community and the ED was better identified. Referrals from other health professionals are often transmitted with the nursing history
component left blank. With the implementation of the discharge nurse, referrals were completed in a timely manner and transmitted with all
the appropriate nursing information included. This allowed the CLSC to institute services safely and efficiently. The CLSC now had a
contact person, who had access to the pertinent information, to whom they could address questions and concerns.
At least three variables do show an increase in satisfaction at the intervention phase as compared to control. For example, those patients
who are depressed and those with very severe chief complaints report more satisfaction in the intervention phase. It might be concluded
that higher satisfaction in this category of patient was as a result of more attention provided by the discharge nurse.
Clarity : There is an, albeit small, but significant difference in the composite score for clarity of information provided. Namely, more patients
in the intervention phase report that the information provided to them was clear to very clear.
Usefulness of information provided at discharge : There is a small difference in perceived usefulness of information between the
intervention and control phase measured 8 days post discharge. However, this difference is not in the desired direction. The intervention
phase report that the information provided about symptom management, medication side effects and progress of symptoms was less
useful.
Satisfaction with discharge process: Here too, we find no significant difference with respect to satisfaction with overall process of
discharge. However, looking at the individual components of this variable we find a significant increase in satisfaction with the
preparedness for discharge ie. information transmitted to the patient and family at discharge(11.5% p=