Acute Respiratory Conditions Requiring Oxygen Therapy, Advanced Practice Nursing, Emergency Service, Hospital, Home Care Services, Home Oxygen Therapy, Patient Discharge
Conditions
Keywords
Advanced practice nurse, Emergency department, Home oxygen therapy, Early supported discharge, Care pathway, Organizational adverse events, Patient experience, Care organization
Brief 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.
Interventions
OTHERAPN-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.
OTHERUsual care: physician-alone management of the Oxy-Urg pathway
Usual care
Sponsors
University Hospital, Strasbourg, France
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adult patient (\>= 18 years) * Affiliated to a social health insurance scheme * Able to understand the objectives and risks of the research and to give dated, signed informed consent * Oxygen-dependent patient eligible for the Oxy-Urg pathway, meeting all of the following: * Stable for more than 12 hours on oxygen therapy in the emergency department * Oxygen requirement \<= 2 L/min (no upward change for 12 hours) * Not socially isolated (relatives able to readily help the patient, living geographically close) * Residing within the provider's geographical area (Bas-Rhin department) * No known pregnancy at inclusion
Exclusion criteria
* Clinical condition requiring hospitalization (decided by the senior physician, per standard of care) * Patient's refusal to enter the pathway * Patient managed outside the emergency APN's working hours * End-of-life patient * Unable to give informed consent (including insufficient understanding of French) * Subject in an exclusion period * Subject under legal protection * Subject under guardianship or curatorship
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| 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. |
Countries
France
Contacts
CONTACTAline CHENOU
Outcome results
None listed