Background/objectives
Telephone follow-up calls could optimize the transition from the emergency department (ED) to home for older patients. However, the effects on hospital return rates are not clear. We investigated whether telephone follow-up reduces unplanned hospitalizations and/or unplanned ED return visits within 30 days of ED discharge.
Design
Pragmatic randomized controlled trial with allocation by month; odd months intervention group, even months control group.
Setting
Two ED locations of a non-academic teaching hospital in The Netherlands.
Participants
Community-dwelling adults aged ≥70 years, discharged home from the ED were randomized to the intervention group (N = 4732) or control group (N = 5104).
Intervention
Intervention group patients: semi-scripted telephone call from an ED nurse within 24 h after discharge to identify post-discharge problems and review discharge instructions. Control group patients: scripted satisfaction survey telephone call.
Measurements
Primary outcome: total number of unplanned hospitalizations and/or ED return visits within 30 days of ED discharge.
Secondary outcomes
separate numbers of unplanned hospitalizations and ED return visits. Subgroup analysis by age, sex, living condition, and degree of crowding in the ED at discharge.
Results
Overall, 42% were males, and median age was 78 years. In the intervention group, 1516 of 4732 patients (32%) consented, and in the control group 1659 of 5104 (33%) patients. Unplanned 30-day hospitalization and/or ED return visit was found in 16% of intervention group patients and 14% of control group patients (odds ratio 1.16; 95% confidence interval: 0.96-1.42). Also, no statistically significant differences were found in secondary outcome measures. Within the subgroups, the intervention did not have beneficial effects for the intervention group.
Conclusion
Telephone follow-up after ED discharge in older patients did not result in reduction of unplanned hospital admissions and/or ED return visits within 30 days. These results raise the question of whether other outcomes could be improved by post-discharge ED telephone follow-up.
© 2021 The Authors. Journal of the American Geriatrics Society published by Wiley Periodicals LLC on behalf of The American Geriatrics Society.
Overview publication
Title | Telephone follow-up to reduce unplanned hospital returns for older emergency department patients: A randomized trial. |
Date | November 1st, 2021 |
Issue name | Journal of the American Geriatrics Society |
Issue number | v69.11:3157-3166 |
DOI | 10.1111/jgs.17336 |
PubMed | 34173229 |
Authors | |
Keywords | emergency department, geriatric, older patients, post-discharge follow-up, telephone |
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