Discharge intervention pilot improves satisfaction for patients and professionals.

Area of Science:

• Internal Medicine
• Nursing Care Management
• Health Services Research

Background:

• Vulnerable, multimorbid patients face high risks of adverse events and information loss post-hospital discharge.
• Poor care coordination at discharge burdens patients, caregivers, and professionals, increasing morbidity and costs.
• Optimizing hospital discharge processes is crucial for improving efficiency and health outcomes.

Purpose of the Study:

• To pilot a discharge management intervention using nurse care managers for high-risk patients.
• To evaluate the impact of the intervention on patient safety, quality of life, and satisfaction.
• To identify necessary design modifications for a larger, adequately powered trial.

Main Methods:

• A single-blind, randomized, controlled pilot study on internal medicine wards.
• Inclusion of 60 high-risk patients (polypharmacy, specific medications, vulnerability criteria).
• Intervention involved nurse care managers; primary endpoint: composite of death, rehospitalization, urgent visit, or adverse medicine reaction within 5 days; secondary endpoints: quality of life, caregiver burden, information adequacy, satisfaction.

Main Results:

• High acceptance of the nurse care manager intervention.
• Significant improvements in patient (p=0.027) and caregiver (p=0.008) satisfaction.
• Higher ratings for discharge information by primary care physicians (p=0.031).
• No significant difference in the primary composite endpoint between groups.

Conclusions:

• Discharge coordination and follow-up by nurse care managers significantly enhance subjective endpoints like satisfaction.
• The pilot identified key design modifications for future research.
• A modified, well-powered study is planned to confirm the intervention's effectiveness.