Rapid two-stage emergency department intervention for seniors: impact on continuity of care.
OBJECTIVE
A two-stage intervention comprising screening and a brief standardized nursing assessment and referral, for emergency department (ED) patients aged 65 years and over, reduced the rate of functional decline four months after the visit, without increasing societal costs. In this study, the authors investigated the effects of the intervention on the process of care at, and during the month after, the ED visit.


METHODS
Patients at four Montreal hospital EDs were randomized by day of visit to the intervention or to usual care. Patients admitted to the hospital were excluded. Measures of process of care included: referrals and visits to the primary physician and to the local community health center, for home care or other services, and return ED visits. Data sources included hospital charts, patient questionnaires, and provincial administrative databases.


RESULTS
The study sample included 166 intervention and 179 control group patients ready for discharge from the ED. Intervention group patients were more likely to have a chart-documented referral to their local community health center [adjusted odds ratio (OR) 4.0, 95% confidence interval (95% CI) = 1.7 to 9.5] and their primary physician [adjusted OR 1.9, 95% CI = 1.0 to 3.4], and to have received home care services one month after the ED visit [adjusted OR 2.3, 95% CI = 1.1 to 5.1]. Unexpectedly, they were also more likely to make a return visit to the ED [adjusted OR 1.6, 95% CI = 1.0 to 2.6].


CONCLUSIONS
The beneficial outcomes of the intervention appear to result primarily from the early provision of home care rather than early contact with the primary physician.
McCusker
Jane
J
Department of Clinical Epidemiology and Community Studies, St. Mary's Hospital, Montréal, Québec, Canada. jane.mccusker@mcgill.ca
Dendukuri
Nandini
N
Tousignant
Pierre
P
Verdon
Josée
J
Poulin de Courval
Louise
L
Belzile
Eric
E
D000368:Aged; D003266:Continuity of Patient Care / Q000458:organization & administration*; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000706:statistics & numerical data; D015577:Geriatric Assessment; D006302:Health Services Research; D006299:Health Services for the Aged / Q000458:organization & administration*; D006699:Home Care Services / Q000706:statistics & numerical data; D006801:Humans; D009730:Nursing Assessment / Q000458:organization & administration*; D010351:Patient Discharge; D011320:Primary Health Care / Q000706:statistics & numerical data; D017064:Process Assessment, Health Care / Q000458:organization & administration*; D011792:Quebec; D012017:Referral and Consultation / Q000706:statistics & numerical data