The impact of an emergency department nursing intervention on continuity of care, self-care capacities and psychological symptoms: secondary outcomes of a randomized controlled trial

Abstract

Background: As yet there is no firm evidence about the types of intervention that can reduce emergency room revisits. However, the literature on emergency room revisits suggests patient difficulties with managing their health problems and treatments after discharge may play a role.

Objectives: We carried out a randomized trial of an emergency department-based nursing intervention, but results showed no reduction in revisits (primary outcome). This paper describes the secondary outcomes of the trial: patient perceptions of continuity of care, illness perceptions, self-care capacities, psychological symptoms and medication adherence 30 days after emergency room discharge.

Design: Randomized, controlled trial.

Settings: The trial was conducted in the emergency department of a tertiary cardiac hospital in Montreal, Canada between November 2007 and March 2010.

Participants: The study involved 203 patients, including 108 in the experimental group and 95 in the control group.

Methods: The intervention included one nurse patient encounter before discharge and two phone calls in the 10 days after discharge. Participants provided data 30 days post-discharge on secondary outcomes potentially related to emergency department revisits.

Results: Although, as previously reported, the intervention had no impact on the primary outcome of emergency department revisits, the present study demonstrated a significant positive effect on patients' perceived continuity of care (p=.033), self-care capacities (p=.037), anxiety (p=.007) and depressive symptoms (p=.043), and the illness perceptions treatment control subscale (p=.037). No differences were found for other illness perception subscales or medication adherence (all p's>.05).

Conclusion: Although the intervention did not influence emergency department revisits it did improve secondary outcomes, suggesting pathways for future research.

Keywords: Clinical trials; Emergencies; Health services utilization; Heart diseases; Nursing care; Quality of health care; Randomized.