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KCE reports vol. 19B Urgences 91
FIRST AUTHOR-
YR-CTRY.
HWANG U.-
2004-USA.
JERANT AF.-
2003-USA.
LATTIMER V.-
1998-UK.
OÊDONNELL
C.-1999-
SCOTLAND.
TYPE STUDY OBJECTIVE(S) METHOD(S) RESULTS DISCUSSION
Systematic
litterature
review.
Randomized
controlled trial.
Block
randomised
controlled trial
over 1 yr.
Critical
systematic
review of
current
knowledge.
Examining how ED overcrowding has
been defined in the medical literature.
Telenursing as a model to reduce
hospitalization for congestive heart
failure: pat-outcome (readmission
rate within 180 days) and nursing
indicators.
Determining the safety and
effectiveness of nurse tel. consult in
out of hours PC.
Examining the radical changes of the
out-of hours care in the new GPCOÊs
from the PC-centers.
Inclusion of reviews, original articles,
editorials, dividing and subdividing those
who defined explicitly or implicitly
overcrowding of ED, and those as
primarily or secondly referring to
overcrowding in their methods and
objectives.
Comparing 3 post-hospitalization nursing
care models: a) video-based telecare,b)
tel. calls,c) usual care.
1 yr,1 Gp-coop.(GPCO),all pats
contacting out of hours recorded
according to deaths within 7 d.of a
contact; ED admission in the 24 hrs; ED
attendance in the 3 d.after contact.
Review of all new models of out of
hours care(equity of access,tel.
advices,home visit-centre
attendance,quality of care): practice
rota,GP employed in ED, nurse triage,
GPCO, PC emeregency centers.
58 % of articles were primarily referring. Of
these 43 % had explicit definitions of crowding
and over crowd. The definitions varied in content
and focus(ED staff and waiting time, hospital
beds, external hosp. factors)
CHFailure readmission rates were lower in the
telenursing grps and these grps had significant
fewer CHF-related ED visits.·In person visits 3
times longer than televisits. Selfcare adherence,
med., health status, satisfaction similar.
50 % of calls were managed without referral to
GPs.69 % of erduction of tel. GP advice; 38 %
reduction of pat. attendance at PC center;23 %
reduction in home visits.
Influence of age on use of out of hours care.More
home visits for elderly,centre visits more
common for children.-Satisfaction unclearly
matched with health outcome. Too little attentio,
and comparaison with single handed GPÊs.
A more consistent approach
to define ED overcrowding
would help to clarify the
distinctions between causes,
features and outcome of
overcrowding.
Telenursing can reduce
significantly CHF
hospitalizations and allow
increased frequency of
communication with patients.
Nurse tel. consults reduce
significanly(50 %)l workload of
GPs,not associated with an
increase in the number of
adverse events.Hence this
model is safe and effective.
Little is known about the
relative merits of the different
types of out of hours
carecurrently provided and
the differences between the
rural and urban areas.A
national comparaison of the
quality and safety for
health,satisfaction,
socioeconomic differences, is
planned in Scotland.