P-429: Impact of a nurse-led transition program on thirty-day hospital readmissions rate of older patients discharged from geriatric short-stay units: results of the PROUST stepped-wedge cluster randomised trial

摘要

Introduction: Older patients are at high risk of ruptures in continuity of care and unplanned readmissions. The aim of this study was to evaluate the impact of a nurse-led program on the rate of unscheduled readmissions of older patients within 30 days from discharge from geriatric short stay units. Methods: Patients aged 75 + with at least two screening criteria for readmission risk derived from the Triage Risk Screening Tool were included in a stepped-wedge cluster randomised trial. The intervention was built around a transition nurse, bridging hospital-to-home transition with 4 weeks post-discharge follow-up (2 home visits and 2 telephone calls). Probabilities of unplanned readmissions or Emergency Department (ED) visits at 30 days were compared using Kaplan—Meier method. A Cox model stratified on the clusters was used to estimate the effect of the intervention. Results: From July 2015 to September 2016, 705 patients were included in 10 units. Presence of community health professionals was improved in the intervention arm (p < 0.001). The rate of 30-day readmission or ED visit was 15.5% in the intervention arm versus 17.6% in the control arm. (HR stratified on clusters: 0.613 [upper limit unilateral 95% CI = 1.11; p = 0.091]). Key conclusions: Despite improved packages of care in the intervention arm, our study does not allow concluding that the nurse-led program was effective at reducing the rate of 30-days unscheduled readmissions in older patients. Further studies are warranted to evaluate this type of program on the longer term and a wider range of patient-related outcomes.