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

Impact of the Advanced Practice Nurse (Emergency Care Specialty) on Complications Related to the Home Discharge of Patients on Oxygen Therapy After Management in the Emergency Department: A Quantitative and Qualitative Study

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.

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