title: Randomized controlled trial of a nursing intervention to reduce emergency department revisits.
abstract: OBJECTIVE
  To determine whether a nursing intervention delivered at emergency department (ED) discharge would reduce ED revisits.
  
  
  METHODS
  A randomized study was conducted in the ED of a tertiary cardiac hospital in Montreal, Quebec. Between November 2006 and March 2010, 3,795 patients were assessed for eligibility based on two risk factors for ED revisits (≥1 ED visit in the past year and ≥6 medications); 132 were randomized to the experimental group (EG) and 133 to the control group (CG). The intervention included one nurse-patient meeting before leaving the ED, with two additional telephone contacts over the next 2 weeks. The primary outcome was time to ED revisits within 30 days after discharge. Secondary outcomes included time to ED revisits over 90, 180, and 365 days and hospitalizations over 30, 90, 180, and 365 days.
  
  
  RESULTS
  A planned interim analysis that stopped the study with half of the planned sample showed that the time to ED revisits was similar in both groups at 30 days (p=0.81; revisits: 18.2% in EG, 19.6% in CG), 90 days (p=0.44), 180 days (p=0.98), and 365 days (p=0.75). The only difference identified was a lower hospitalization proportion at 180 days in the EG group (13.6% v. 24.1%; p=0.038).
  
  
  CONCLUSIONS
  These findings are consistent with previous research showing that few ED-based interventions are successful in reducing ED returns. Factors other than those targeted by the intervention, including an improvement in usual care, may explain the findings.
authors.affiliation: *Faculty of Nursing,University of Montreal, andMontreal Heart Institute Research Center.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Cossette
authors.affiliation: †Emergency Department,Montreal Heart Institute.
authors.forename: Alain
authors.initials: A
authors.lastname: Vadeboncoeur
authors.affiliation: ‡Faculty of Psychiatry and Nursing,McGill University, andCentre hospitalier de l'Université de Montréal, andMontreal Heart Institute Research Center.
authors.forename: Nancy
authors.initials: N
authors.lastname: Frasure-Smith
authors.affiliation: §Department of Epidemiology,Biostatistics, and Occupational Health,McGill University, andSt. Mary's Research Centre.
authors.forename: Jane
authors.initials: J
authors.lastname: McCusker
authors.affiliation: †Emergency Department,Montreal Heart Institute.
authors.forename: Danielle
authors.initials: D
authors.lastname: Perreault
authors.affiliation: ∥Department of Biostatistics,Montreal Health Innovations Coordinating Center,Montreal,QC.
authors.forename: Marie-Claude
authors.initials: MC
authors.lastname: Guertin
mesh_terms: D000368:Aged; D003266:Continuity of Patient Care / Q000458:organization & administration*; D016638:Critical Illness / Q000451:nursing*; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009723:Nurse-Patient Relations; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge / Q000639:trends; D010359:Patient Readmission / Q000639:trends*; D011792:Quebec; D012189:Retrospective Studies
keywords: randomized controlled trial