Department of Emergency Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC; Division of Geriatric Medicine, Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC.
Acad Emerg Med. 2014 Feb;21(2):188-95. doi: 10.1111/acem.12308.
Older patients discharged from the emergency department (ED) have difficulty comprehending discharge plans and are at high risk of adverse outcomes. The authors investigated whether a postdischarge telephone call-mediated intervention by a nurse would improve discharge care plan adherence, specifically by expediting post-ED visit physician follow-up appointments and/or compliance with medication changes. The second objectives were to determine if this telephone call intervention would reduce return ED visits and/or hospitalizations within 35 days of the index ED visit and to determine potential cost savings of this intervention.
This was a 10-week randomized, controlled trial among patients aged 65 and older discharged to home from an academic ED. At 1 to 3 days after each patient's index ED visit, a trained nurse called intervention group patients to review discharge instructions and assist with discharge plan compliance; placebo call group patients received a patient satisfaction survey call, while the control group patients were not called. Data collection calls occurred at 5 to 8 days and 30 to 35 days after the index ED visits for all three groups. Chi-square or Fisher's exact tests were performed for categorical data and the Kruskal-Wallis test examined group differences in time to follow-up.
A total of 120 patients completed the study. Patients were 60% female and 72% white, with a mean age of 75 years (standard deviation [SD] ± 7.58 years). Intervention patients were more likely to follow up with medical providers within 5 days of their ED visits than either the placebo or the control group patients (54, 20, and 37%, respectively; p = 0.04). All groups performed well in medication acquisition and comprehension of medication indications and dosage. There were no differences in return visits to the ED or hospital within 35 days of the index ED visit for intervention patients, compared to placebo or control group patients (22, 33, and 27%, respectively; p = 0.41). An economic analysis showed an estimated 70% chance that this intervention would reduce total costs.
Telephone call follow-up of older patients discharged from the ED resulted in expedited follow-up for patients with their primary care physicians. Further study is warranted to determine if these results translate into improved patient outcomes, decreased return ED visits or hospital admissions, and cost savings resulting from this intervention.
从急诊科（ED）出院的老年患者在理解出院计划方面存在困难，并且存在发生不良后果的高风险。作者研究了由护士进行的出院后电话介导干预是否会改善出院护理计划的依从性，特别是通过加快 ED 就诊后医生随访预约和/或遵守药物更改。第二个目标是确定这种电话干预是否会减少 35 天内 ED 再次就诊和/或住院的情况，并确定这种干预的潜在成本节约。
这是一项针对从学术 ED 出院的 65 岁及以上患者的为期 10 周的随机对照试验。在每位患者 ED 就诊后的 1 至 3 天，经过培训的护士会致电干预组患者，以审查出院医嘱并协助遵守出院计划；而安慰剂组患者则会接到患者满意度调查电话，而对照组患者则不会接到电话。在所有三组患者中，在 ED 就诊后 5 至 8 天和 30 至 35 天进行数据收集电话呼叫。对于分类数据，进行了卡方或 Fisher 确切检验，而 Kruskal-Wallis 检验则检验了组间随访时间的差异。
共有 120 名患者完成了研究。患者中 60%为女性，72%为白人，平均年龄为 75 岁（标准差 [SD] ± 7.58 岁）。与安慰剂或对照组患者相比，干预组患者更有可能在 ED 就诊后 5 天内与医疗提供者进行随访（分别为 54%、20%和 37%；p = 0.04）。所有组在获取药物和理解药物适应症和剂量方面表现良好。与安慰剂或对照组患者相比，干预组患者在 ED 就诊后 35 天内再次就诊或住院的情况没有差异（分别为 22%、33%和 27%；p = 0.41）。经济分析显示，该干预措施有 70%的可能性会降低总费用。
对从 ED 出院的老年患者进行电话随访可加快患者与初级保健医生的随访。需要进一步研究以确定这些结果是否转化为改善患者结局、减少 ED 再次就诊或住院以及该干预措施带来的成本节约。
