Impact of an Emergency Advanced Practice Nurse on Complications After Home Discharge of Oxygen-Dependent Patients Managed in the Emergency Department: A Quantitative and Qualitative Study

Condition(s) studied

Investigational drug(s) / intervention(s)

APN-physician team management of the Oxy-Urg pathway: Organizational intervention: the emergency advanced practice nurse and the emergency physician jointly manage the inclusion of the patient in the Oxy-Urg pathway and the organization of the home discharge on oxygen.

Usual care: physician-alone management of the Oxy-Urg pathway: Usual care

Study summary

Since the COVID-19 pandemic, discharging patients home on low-flow oxygen therapy has proven to be a safe and effective alternative to hospitalization, helping to relieve overcrowded hospitals while ensuring continuity of care. At the investigating emergency department, a dedicated care pathway ("Oxy-Urg") already allows selected oxygen-dependent patients to return home with a home-care provider, regardless of the cause of their breathlessness, once their condition is stable.

This study evaluates whether managing these patients with a team combining an emergency advanced practice nurse (APN) and an emergency physician, rather than a physician alone, improves the organization of care and reduces complications after home discharge.

Adult oxygen-dependent patients eligible for the Oxy-Urg pathway are randomly assigned (1:1) to management by an APN-physician team (intervention group) or by a physician alone (control group). Both groups then receive the usual Oxy-Urg pathway (home oxygen therapy, provider tele-monitoring, community nurse and general practitioner follow-up).

The main goal is to compare the number of organizational adverse events occurring between inclusion and Day 28 between the two groups. The study also assesses clinical deterioration after discharge, the time professionals spend setting up the pathway, and, through interviews and a focus group, the experience of patients and professionals. The hypothesis is that the APN-physician team allows a more efficient organization and improves the patient experience, supporting the sustainability and wider use of this pathway.

Eligibility

Primary outcome measure(s)

• Proportion of patients with at least one organizational adverse event related to home discharge on oxygen — From inclusion (Day 0) to Day 28
  At least one of the following organizational adverse events: (1) total pathway inclusion time greater than 20 minutes; (2) administrative error or omission regarding prescriptions, the liaison file or handover; (3) time to home oxygen availability exceeding the protocol target; (4) initial technical difficulty of the equipment requiring corrective action by the provider; (5) non-compliance with instructions given to home caregivers, evidenced by a documented non-conformity; (6) nurse visit not compliant with the prescription, observed and recorded.

Trial sites (1)

More University Hospital, Strasbourg, France trials in France

Other trials for the same condition