An emergency department-based nurse discharge coordinator for elder patients: does it make a difference?
OBJECTIVE
To evaluate the impact of an emergency department (ED)-based nurse discharge plan coordinator (NDPC) on unscheduled return visits within 14 days of discharge, satisfaction with discharge recommendations, adherence with discharge instructions, and perception of well-being of elder patients discharged from the ED.


METHODS
Patients aged 75 years and older discharged from the ED of the Sir Mortimer B. Davis-Jewish General Hospital were recruited in a pre/post study. During the pre (control) phase, study patients (n = 905) received standard discharge care. Patients in the post (intervention) phase (n = 819) received the intervention of an ED-based NDPC. The intervention included patient education, coordination of appointments, patient education, telephone follow-up, and access to the NDPC for up to seven days following discharge.


RESULTS
Patients in the two groups were similar with respect to gender and age. However, the patients managed by the ED NDPC appeared to be, at baseline, less autonomous, frailer, and sicker. The unadjusted relative risk for unscheduled return visits within 14 days of discharge was 0.79 (95% confidence interval [95% CI] = 0.62 to 1.02). A relative risk reduction of 27% (95% CI = 0% to 44%) for unscheduled return visits was observed for up to eight days postdischarge, and a relative risk reduction of 19% (95% CI = -2% to 36%) for unscheduled return visits was observed for up to 14 days postdischarge. Significant increases in satisfaction with the clarity of discharge information and perceived well-being were also noted.


CONCLUSIONS
An ED-based NDPC, dedicated specifically to the discharge planning care of elder patients, reduces the proportion of unscheduled ED return visits and facilitates the transition from ED back home and into the community health care network.
Guttman
Alex
A
Emergency Department, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, Quebec, Canada. alex.guttman@mcgill.ca
Afilalo
Marc
M
Guttman
Rivka
R
Colacone
Antoinette
A
Robitaille
Chantal
C
Lang
Eddy
E
Rosenthal
Stephen
S
D000368:Aged; D000369:Aged, 80 and over; D016529:Emergency Nursing / Q000379:methods*; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000706:statistics & numerical data; D005500:Follow-Up Studies; D006299:Health Services for the Aged / Q000458:organization & administration*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D010043:Outcome and Process Assessment, Health Care; D010349:Patient Compliance / Q000706:statistics & numerical data; D010351:Patient Discharge; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011446:Prospective Studies; D011792:Quebec; D012306:Risk