Impact of a transition nurse program on the prevention of thirty-day hospital readmissions of elderly patients discharged from short-stay units: study protocol of the PROUST stepped-wedge cluster randomised trial

Pauline Occelli, Sandrine Touzet, Muriel Rabilloud, Christell Ganne, Stéphanie Poupon Bourdy, Béatrice Galamand, Matthieu Debray, André Dartiguepeyrou, Michel Chuzeville, Brigitte Comte, Basile Turkie, Magali Tardy, Jean-Stéphane Luiggi, Thierry Jacquet-Francillon, Thomas Gilbert, Marc Bonnefoy, Pauline Occelli, Sandrine Touzet, Muriel Rabilloud, Christell Ganne, Stéphanie Poupon Bourdy, Béatrice Galamand, Matthieu Debray, André Dartiguepeyrou, Michel Chuzeville, Brigitte Comte, Basile Turkie, Magali Tardy, Jean-Stéphane Luiggi, Thierry Jacquet-Francillon, Thomas Gilbert, Marc Bonnefoy

Abstract

Background: In France, for patients aged 75 or older, it has been estimated that the hospital readmission rate within 30 days is 14 %, a quarter being avoidable. Some evidence suggests that interventions "bridging" the transition from hospital to home and involving a designated professional (usually nurses) are the most effective in reducing the risk of readmission, but the level of evidence of current studies is low. Our study aims to assess the impact of a care transition program from hospital to home for elderly admitted to short-stay units.

Methods: This is a multicentre, stepped-wedge cluster randomised trial. The program will be implemented at three times of the transition: 1) during the patient's stay in hospital: development of a discharge plan, creation of a transitional care file, and notification of the primary care physician about inpatient care and hospital discharge by the transition nurse; 2) on the day of discharge: meeting between the transition nurse and the patient to review the follow-up recommendations; and 3) for 4 weeks after discharge: follow-up by the transition nurse. The primary outcome is the 30-day unscheduled hospital readmission or emergency visit rate after the index hospital discharge. The patients enrolled will be aged 75 or older, hospitalized in an acute care geriatric unit, and at risk of hospital readmission or an emergency visit after returning home. In all, 630 patients will be included over a 14-month period. Data analysis will be blinded to allocation, but due to the nature of the intervention, physicians and patients will not be blinded.

Discussion: Our study makes it possible to evaluate the specific effect of a bridging intervention involving a designated professional intervening before, during, and after hospital discharge. The strengths of the study design are methodological and practical. It permits the estimation of the intervention effect using between- and within-cluster comparisons; the study of the fluctuations in unscheduled hospital readmission or emergency visit rates; the participation of all clusters in the intervention condition; the implementation of the intervention in each cluster successively.

Trial registration: This study has been registered as a cRCT at clinicaltrials.gov (identifier: NCT02421133 ). Registered 9 March 2015.

Figures

Fig. 1
Fig. 1
Stepped-wedge study with a continuous recruitment, short exposure design. Shaded areas indicate transition program exposure and unshaded areas indicate control exposure
Fig. 2
Fig. 2
Follow-up within 4 weeks of hospital discharge

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