Table 2 Characteristics, outcome measures, and feasibility of included studies

Setting, country

Academic center ED, USA

Academic center ED, USA

Study design

RCT

RCT

Aim(s)

To investigate whether an ED postdischarge telephone intervention by nurse improves discharge plan adherence.

To investigate whether an ED postdischarge telephone intervention by call-center nurse decreases ED return visit rates, hospitalization or death within 30 days after ED visit.

Study period

From September 5 until November 9, 2010

From August 2013 to March 2016

Study patients

Patients ≥65 years, discharged home from ED

Patients ≥65 years, discharged home from ED

Recruitment of study patients

Randomization before first call

Recruitment by telephone after mental cognition screening examination was passed and informed consent was obtained.

Recruitment by telephone after mental cognition screening examination was passed and informed consent was obtained.

Subsequent randomization.

Description of intervention: intervention group

Telephone call following pre-written script from trained study nurse within 1–3 days after ED discharge to review discharge instructions and offer assistance with discharge plan compliance.

Telephone call following pre-written script from call-center nurse within 1–3 days after ED discharge to identify problems, review discharge instructions and offer assistance with discharge plan compliance, advice if not feeling well.

Description of intervention: control group(s)

Placebo group: scripted patient satisfaction survey telephone call from research assistant 1–3 days after ED discharge.

Control group: no telephone intervention

Scripted patient satisfaction survey telephone call from call-center nurse 1–3 days after ED discharge.

Sample size

Intervention group: n=39; placebo group: n=35; control group: n=46

Intervention group: n=999; control group: n=1001

Outcome measures

Primary outcome measures:

Scheduled physician appointment within 5 days.

Filled medication prescription.

Knowledge of name, dosage, indication of prescribed medication.

Primary outcome measures:

Days from ED discharge to ED return visit, 30-day hospitalization or death.

Secondary outcome measures:

35-day hospitalization

35-day ED return visits

Secondary outcome measures:

Scheduled physician appointment within 30 days.

Difficulty acquiring prescribed medication.

Results of outcome measures

Primary outcome measures:

Physician appointment ≤ 5 days: 54% (I), 20% (P), 37%(C); p=0.04

Filled prescription: 96% (I), 94%(P), 94% (C); NS.

Knowledge name/dosage of medication: 92%(I), 94%(P), 89%(C); NS.

Knowledge of reason for medication: 96%(I), 100% (P), 100%(C); NS.

Primary outcome measures:

ED return visits ≤30 days: 12.2% (I) vs. 12.5% (C); NS.

Hospitalization ≤30 days: 9.0% (I) vs. 7.4%(C); NS.

Death ≤30 days: 0%(I) vs. 0.51% (C); NS.

Secondary outcome measures:

ED return visits/hospitalization ≤35 days: 22%(I), 33%(P), 27%(C); NS.

Secondary outcome measures:

Physician appointment ≤ 30 days: 80.8% (I) vs. 80.8%(C); NS.

Difficulty acquiring medication: 15.5% (I) vs. 15.6%(C); NS.

Feasibility

178 eligible patients: 120 (67%) included, 18 (10%) declined and 19 (11%) not reached during follow-up. 12 (7%) Were disqualified from primary outcome analysis, because of return to ED or other hospital setting within 5 days. Three were excluded for other reasons. Six had incomplete surveys.

No patients failed mental screening examination. Inclusions only on Sunday, Monday, Tuesday, and not more than 9 inclusions per day.

Of the 6463 eligible patients, 2000 (31%) consented to participate. 2712 (42%) Patients were not reached, 1683 (45%) patients who were reached declined participation, 37 were lost on call back and 31 failed mental screening examination.

Inclusions 24/7.