Telephone follow-up to reduce unplanned hospital returns for older emergency department patients: A randomized trial

Abstract

Background/objectives: Telephone follow-up calls could optimize the transition from the emergency department (ED) to home for older patients. However, the effects on hospital return rates are not clear. We investigated whether telephone follow-up reduces unplanned hospitalizations and/or unplanned ED return visits within 30 days of ED discharge.

Design: Pragmatic randomized controlled trial with allocation by month; odd months intervention group, even months control group.

Setting: Two ED locations of a non-academic teaching hospital in The Netherlands.

Participants: Community-dwelling adults aged ≥70 years, discharged home from the ED were randomized to the intervention group (N = 4732) or control group (N = 5104).

Intervention: Intervention group patients: semi-scripted telephone call from an ED nurse within 24 h after discharge to identify post-discharge problems and review discharge instructions. Control group patients: scripted satisfaction survey telephone call.

Measurements: Primary outcome: total number of unplanned hospitalizations and/or ED return visits within 30 days of ED discharge.

Secondary outcomes: separate numbers of unplanned hospitalizations and ED return visits. Subgroup analysis by age, sex, living condition, and degree of crowding in the ED at discharge.

Results: Overall, 42% were males, and median age was 78 years. In the intervention group, 1516 of 4732 patients (32%) consented, and in the control group 1659 of 5104 (33%) patients. Unplanned 30-day hospitalization and/or ED return visit was found in 16% of intervention group patients and 14% of control group patients (odds ratio 1.16; 95% confidence interval: 0.96-1.42). Also, no statistically significant differences were found in secondary outcome measures. Within the subgroups, the intervention did not have beneficial effects for the intervention group.

Conclusion: Telephone follow-up after ED discharge in older patients did not result in reduction of unplanned hospital admissions and/or ED return visits within 30 days. These results raise the question of whether other outcomes could be improved by post-discharge ED telephone follow-up.

Keywords: emergency department; geriatric; older patients; post-discharge follow-up; telephone.

FIGURE 1

Flow diagram of enrollment and study groups. CG, control group; IG, intervention group; n, number. *Eight odd months during the study period; #9 even months during the study period

FIGURE 2

Risk of unplanned hospitalization and/or ED return visit within 30 days, depending on the study group. CG, control group; CI, confidence interval; ED, emergency department; IG, intervention group; NEDOCS, National Emergency Department OverCrowding Scale. *Living condition unknown in 327 intervention group patients and 367 control group patients. ^NEDOCS at discharge unknown in 5 intervention group patients and 175 control group patients