Telephone Follow-Up for Older Adults Discharged to Homefrom the Emergency Department: A Pragmatic Randomized Controlled Trial

• Autores: Kevin J. Biese, Jan Busby Whitehead, Jianwen Cai, Sally C. Stearns, Ellen Roberts, Paul Mihas, Doug Emmett, Qingning Zhou, Franklin Farmer, John S. Kizer
• Localización: Journal of the American Geriatrics Society, ISSN 0002-8614, Vol. 66, Nº. 3, 2018, págs. 452-458
• Idioma: inglés
• Enlaces
  • Texto Completo Ejemplar
• Resumen

  • BACKGROUND/OBJECTIVES: Telephone calls after dis-charge from the emergency department (ED) are increasinglyused to reduce 30-day rates of return or readmission, buttheir effectiveness is not established. The objective was todetermine whether a scripted telephone intervention by regis-tered nurses from a hospital-based call center would decrease30-day rates of return to the ED or hospital or of death.DESIGN: Randomized, controlled trial from 2013 to 2016.SETTING: Large, academic medical center in the south-east United States.PARTICIPANTS: Individuals aged 65 and older dis-charged from the ED were enrolled and randomized intointervention and control groups (N = 2,000).INTERVENTION: Intervention included a telephone callfrom a nurse using a scripted questionnaire to identifyobstacles to elements of successful care transitions: medica-tion acquisition, postdischarge instructions, and obtainingphysician follow-up. Control subjects received a satisfac-tion survey only.MEASUREMENTS: Primary outcome was return to theED, hospitalization, or death within 30 days of dischargefrom the ED.RESULTS: Rate of return to the ED or hospital or deathwithin 30 days was 15.5% (95% confidence interval(CI) = 13.2–17.8%) in the intervention group and 15.2%(95% CI = 12.9–17.5%) in the control group (P = .86).Death was uncommon (intervention group, 0; control group, 5 (0.51%), 95% CI = 0.06–0.96%); 12.2% ofintervention subjects (95% CI = 10.1–14.3%) and 12.5%of control subjects (95% CI = 10.4–14.6%) returned tothe ED, and 9% of intervention subjects (95% CI = 7.2–10.8%) and 7.4% of control subjects (95% CI = 5.8–9.0%) were hospitalized within 30 days.CONCLUSION: A scripted telephone call from a trainednurse to an older adult after discharge from the ED didnot reduce ED or hospital return rates or death within 30 days. Clinicaltrials.gov identifier: NCT01893931z.