Nurse-Led Call Back Program to Improve Patient Follow-Up With Providers After Discharge From the Emergency Department

Abstract

Phone calls to patients after discharge from the emergency department (ED) serve as reminders to schedule medical follow-up, support adherence to discharge instructions, and reduce revisits to already-crowded EDs. An existing, nurse-administered, call-back program contacted randomly selected ED patients 24 to 48 hours following discharge. This program did not improve patient follow-up (48.68%) nor reduce the ED revisit rate (6.7% baseline vs 6.0% postimplementation). Plan-Do-Study-Act methodology tested a modification to the existing program consisting of a second, scripted phone call from a trained volunteer at 72 to 96 hours postdischarge. Volunteers utilized a patient list and script, and nurses provided expertise to eliminate identified barriers to follow-up. Follow-up rate and ED revisit were monitored through the electronic medical record. A total of 894 patients participated between October 2017 and June 2018. Follow-up increased from 48.68% to 65.5% (P < .0001) and ED revisit decreased significantly (4.5% vs 8.6%, P < .001). This innovative nurse-led, systematic postdischarge call-back program utilizing hospital volunteers increased patient compliance with post-ED medical follow-up while significantly reducing the rate of patient revisit to the ED within 7 days of discharge.

Keywords: clinician–patient relationship; communication; nursing; patient engagement; patient feedback; quality improvement; transitions of care.

Figure 1.

Patient revisit rate to ED* within 7 days of index visit. *Two noncritical, lower-acuity care areas only. ^ŦIntervention group, PDSA cycles 1 to 3; all patients received at least the baseline, standard call from a nurse at 24 to 48 hours after discharge; eligible patients (n = 894) additionally received a second call at 72 to 96 hours from a hospital volunteer. ^aThese patients, originating from the same lower-acuity care areas and during the same time frame as the intervention group, did not receive any discharge phone calls. FY indicates fiscal year; ED, emergency department; PDSA, Plan-Do-Study-Act.

Figure 2.

Statistical quality control p chart* showing biweekly percentage of patient compliance with post ED discharge follow-up. *Red lines represent the upper and lower control limits within 3-standard deviations of the mean (3-sigma limits); these vary in response to the sample size, with statistically significant data points above the red line. Baseline data: Initial call-back program; single call by nurse at 24 to 48 hours following discharge. PDSA cycle #1: Call by nurse at 24 to 48 hours following discharge with second call at 72 to 96 hours following discharge utilizing “health leads” volunteers; limited to patients established within 4 hospital-based, primary and specialty practice groups. PDSA cycle #2: Call by nurse at 24 to 48 hours following discharge with second call at 72 to 96 hours following discharge utilizing “health leads” and “hospital-wide” volunteers; expanded to also include all hospital-based community clinic patients. PDSA cycle #3: Call by nurse at 24 to 48 hours following discharge with second call at 72 to 96 hours following discharge utilizing hospital-wide volunteers only; full expansion of program to include patients of all enterprise-based providers. ED indicates emergency department; PDSA, Plan-Do-Study-Act.

Figure 3.

Percentage of patients completing post-ED follow-up care, by PDSA cycle. Error bars indicate standard error. Baseline data: Initial call-back program; single call by nurse at 24 to 48 hours following discharge. PDSA cycle #1: Call by nurse at 24 to 48 hours following discharge with second call at 72 to 96 hours following discharge utilizing “health leads” volunteers; limited to patients established within 4 hospital-based, primary and specialty practice groups. PDSA cycle #2: Call by nurse at 24 to 48 hours following discharge with second call at 72 to 96 hours following discharge utilizing “health leads” and “hospital-wide” volunteers; expanded to also include all hospital-based community clinic patients. PDSA cycle #3: Call by nurse at 24 to 48 hours following discharge with second call at 72 to 96 hours following discharge utilizing hospital-wide volunteers only; full expansion of program to include patients of all enterprise-based providers. ED indicates emergency department; PDSA, Plan-Do-Study-Act.