The effects of Nurse Led Transitional Care Model on elderly patients undergoing open heart surgery: a randomized controlled trial

Abstract

Aims: Rate and number of successful cases in open heart surgery has been increasing due to the advances in medical technology and surgery. To improve patient convalescence results and reduce rate of post-discharge readmission to hospital and unplanned post-discharge rehospitalization, home-care and follow-up process of patients should be managed successfully. To evaluate the effectiveness of Nurse Led Transitional Care Model on the functional autonomy, quality of life, readmission, and rehospitalization rates of elderly patients undergoing open heart surgery. A randomized controlled trial was conducted from November 2017 to December 2018 and performed according to the CONSORT Guidelines.

Methods and results: Sixty-six elderly patients were randomly allocated to the intervention (n: 33) and control (n: 33) groups. Patients in intervention group were given care based on the Transitional Care Model until the post-discharge 9th week starting from date of hospitalization. Patients in control group were given standard care services. Functional autonomy, quality of life levels, and repeated admission/re-hospitalization rates to the clinic were evaluated. The Functional Autonomy Measurement System and SF-36 Quality of Life Scale scores of the intervention group were higher than that of the control group at the 9th week (P < 0.05). In addition, rate of readmission and rehospitalization during the follow-up period (6 months) of patients in the intervention group was found to be lower than the patients in the control group (P < 0.05).

Conclusion: Care services offered under the Transitional Care Model improved functional autonomy and quality of life and decreased post-discharge hospital readmission and rehospitalization rates of patients.

Trial registration: The study was registered on ClinicalTrials.gov (ID: NCT04384289).

Keywords: Autonomy; Elderly; Heart surgery; Nurse-led intervention; Quality of life; Transitional Care Model.