Is Anyone Home? The Association Between Being Reached for a Postdischarge Phone Call and 30‐Day Hospital Readmission

Background:

Several care transition interventions have proposed that postdischarge phone calls reduce adverse events, increase patient engagement, and decrease costly return visits to the hospital. However, given the multifaceted nature of most care transitions interventions, the true relationship between postdischarge phone calls and readmissions is uncertain.

Methods:

From June of 2010 to May 2012, 4 nurses at a 600‐bed academic medical center aimed to call all 5848 patients returning home within 72 hours of discharge from the inpatient medicine service. Patients with no listed phone number, those who were already readmitted at the time of the call, and those who had died were not called. Making at least 2 call attempts per patient, nurses followed a standard script to address common issues associated with hospital readmission with the patient or the caregiver. A database of calls was used to determine whether a call had been made and if a patient or caregiver had answered the call. Administrative data were used to capture all inpatient admissions and readmissions to the medicine service during this period. Three hundred forty‐one patients were excluded because of readmission in less than 72 hours, multiple readmissions within 30 days, and readmission to or from a service other than the medicine service. We aimed to determine the association between receiving a phone call and a 30‐day readmission greater than 72 hours after discharge using chi‐square tests. A comparison of the characteristics of patients by call complete group was performed using t and chi‐square tests.

Results:

Of the 5507 eligible patients, 4115 patients (74.7%) received a phone call. Two thousand six hundred eighty patients (65.1%) were reached, and 1435 (34.9%) could not be reached after 2 call attempts. Of those who were called, patients who were reached were significantly older, more likely to have Medicare as the primary payer, and less likely to be self‐pay (Table 1). After excluding multiple readmissions and readmissions within 72 hours, the overall readmission rate for those receiving a call was 6.8%. However, patients who were reached for the call were significantly less likely to be readmitted (155 of 2680 [5.8%] vs. 124 of 1435 [8.6%]; P < 0.001).

Conclusions:

Patients who were reached for the call were older, more likely to have Medicare, and had a trend toward higher severity of illness and risk of mortality, but they were less likely to be readmitted. Our findings suggest that patients not able to be reached may have other risks for readmission and may require more intensive interventions.