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
6. POTENTIEL DE GÉNÉRALISATION
6.1 Pérennité The success of the model continues to be demonstrated by the acceptance and the investment by hospital administrators into the creation,
in October 2000, of a new position of nurse discharge coordinator dedicated to the ED. The nursing intervention model, designed for the
study, continues to be played out in practice. The efforts now are concentrated on patients whose characteristics were identified in the
study as being at risk. The study has also identified key characteristics of patients that make them at high risk for revisit. Continuity of care
beyond the ED visit continues. Patients who are at higher risk are provided with follow up phone calls the next day and all patients are
given the nurses business card. Patients continue to contact the discharge nurse seeking clarification of information, assistance with
appointments and community services or simply reassurance. The network integration team also continues to meet on a regular basis.
6.2 Conditions nécessaires Future Directions: We believed that the discharge needs of the “healthy” elderly are often underestimated. The project was, therefore,
designed to address the discharge needs of all patients over the age of seventy-five. With the time and resource constraints of the project,
it was unrealistic to target this entire geriatric population. Therefore, the results of the study may have been limited by sample selection, in
that, many patients recruited were not considered frail. Future studies using a risk assessment tool to target the more frail elderly
identifiable would be suggested.
Aspects of successful discharge planning were identified. These included adequate time to assess and address the needs of the
patient/family unit, building close and trusting ties with the community agencies, and most importantly the availability to the patient by
phone to discuss problems/concerns.
The successful implementation of a nurse discharge coordinator depends on a number of factors. First and foremost, is the integration of
this individual into the ED medical/nursing team. The ED staff needs to go through a learning curve to understand and value the role of the
discharge nurse. Early in the study, recruited patients were lost because the ED staff did not notify the discharge nurse that the patient was
ready to go home.
Communication with the community agencies is vital. The discharge coordinator must act as that all important link between the hospital
and community.
Much of the work of the discharge coordinator is away from the bedside. The discharge coordinator must have a dedicated workspace
away from the bustle of the ED where the patient/family may be interviewed and not be pressed for new access to the patient’s stretcher. A
dedicated telephone and computer to access patient information and transmit referrals was found to be indispensable.
6.3 Avantages généralisation Puisque le processus de planification des congés est déjà bien assimilé et utilisé largement pour la clientèle hospitalisée, l'implantation de
cette intervention à grande échelle, tant dans les départements d'urgence de Montréal que dans ceux du reste du Québec et des autres
provinces, semble réaliste et prometteuse.
The impact of the intervention, however, goes beyond the two-week study period. Patients with trivial appearing complaints often have
serious underlying health and social needs that are unmet. These patients often slip through the cracks in a busy emergency department.
A nurse discharge coordinator would have the time to help identify and address these needs. These patients, if needed, would then be
referred back to the community into a “guichet unique” system.
Cost Effectiveness : Although the study did not include a cost analysis, certainly the reduction in return visits to the hospital should
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