Faculty of Medicine, University of Western Australia.
Clinical Sciences, Harry Perkins Institute of Medical Research, Nedlands, Western Australia.
Eur J Emerg Med. 2018 Aug;25(4):237-241. doi: 10.1097/MEJ.0000000000000444.
The risk of early reattendance after discharge has been proposed as a performance indicator for emergency departments (EDs), but is not uniform in all patients. Those individuals at the highest risk of reattendance may benefit from an intense intervention to reduce this risk, and our objective was to test this hypothesis in a clinical trial.
A randomized-controlled trial was conducted in the EDs of two hospitals. Very high-risk adults aged 65 years and older, identified using a validated risk-prediction nomogram and being discharged from ED, were randomized to receive a postdischarge patient-centred intervention or standard care. The intervention focused on identifying and supporting patients to address risk factors for future hospital presentation. The primary outcome measure was any unplanned ED reattendance within 28 days. Secondary outcomes included 28-day and 1-year hospital usage, institutionalization and death.
We enrolled 164 patients, 82 in each study arm. There was an 8% absolute (95% confidence interval: -7%-20%) and a 20% relative risk reduction for an intervention patient making an unplanned ED reattendance within 28 days. This difference was not statistically significant (P=0.26).
This postdischarge intervention was associated with only small and nonsignificant reductions in ED reattendance.
出院后早期再次就诊的风险已被提出作为急诊科（ED）的绩效指标，但并非所有患者都适用。那些再次就诊风险最高的患者可能受益于强化干预以降低这种风险，我们的目的是在临床试验中验证这一假设。
在两家医院的急诊科进行了一项随机对照试验。使用经过验证的风险预测列线图识别出非常高风险的 65 岁及以上成年人，这些患者从 ED 出院后被随机分配接受出院后以患者为中心的干预或标准护理。干预的重点是识别和支持患者解决未来就诊的风险因素。主要结局指标是 28 天内任何无计划的 ED 再次就诊。次要结局指标包括 28 天和 1 年的医院使用情况、住院和死亡。
我们共纳入了 164 名患者，每组 82 名。干预组患者在 28 天内无计划再次就诊的绝对风险降低了 8%（95%置信区间：-7%-20%），相对风险降低了 20%。但这一差异无统计学意义（P=0.26）。
这种出院后干预仅导致 ED 再次就诊的风险略有且无统计学意义的降低。
