Clinical Briefs
Nurse-centered discharge planning saves money
By Joan Unger, RN, MS, ARNP-C
A randomized trial evaluated the effectiveness of a special discharge plan for elderly (age > 65) hospitalized patients set up and carried out largely by advanced practice nurses (APNs). Investigators enrolled 363 patients in the study, 177 in the intervention group and 186 in the control group. Subjects had been admitted to the hospital with one of these diagnoses: angina, coronary artery bypass graft, coronary heart failure, cardiac valve replacement, major small- or large-bowel procedure, myocardial infarction, orthopedic procedures of lower extremities, or respiratory tract infection.
Control group patients received the hospital’s standard discharge planning and home care. Intervention group patients received a specifically designed discharge plan and home follow-up protocol especially for elders at high risk for poor outcomes following hospital discharge. The plan included contact with one APN throughout the hospital stay. The initial contact occurred within 48 hours of hospital admission, and every 48 hours during hospitalization.
At least two home visits were scheduled, one within 48 hours of discharge, the second 7-10 days post-discharge. Additional APN visits or telephone contacts were unlimited and based on patient need. APN interventions focused on activity, diet, emotional status, medical follow-up, medications, sleep, and symptom management.
The study found that by week 24 after hospital discharge, 20% of the study patients had been readmitted, compared with 37% of the control patients (p < .001). In the control group, 25% were readmitted within 48 days following hospital discharge. Only 25% of intervention patients were readmitted within 133 days. The intervention group had fewer hospital days per patient and fewer patients with multiple readmissions.
Source
Naylor M, Brooten D, Campbell R, et al. Comprehensive discharge planning and home follow-up of hospitalized elders. JAMA 1999;281:613-620.
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