Background:
Posthospitalization phone calls have been proposed as a means to reduce postdischarge adverse events, increase patient satisfaction, and reduce costly return visits to the hospital. Some programs have utilized hospital‐based nurses to provide follow‐up calls, but the outcomes of these interventions have not been well described.
Methods:
After a 3‐month pilot on a single unit, 4 bedside nurses began calling all patients discharged home from the medicine service at a large academic medical center. All patients received 2 phone call attempts within 72 hours of leaving the hospital. Nurses followed a standard script to address patient questions and concerns and worked to troubleshoot issues arising after hospital discharge. Their findings were documented in a templated note in the electronic medical record. If an intervention was required, nurses performed and documented a second follow‐up call to assess the success of their intervention. Notes were audited for areas of nursing intervention including discharge or medication instructions, discharge prescriptions, follow‐up appointments, and home care (services and supplies).
Results:
During the 5‐month audit, the nurses made 933 phone calls and reached 699 patients and caregivers (70%). An instructional message with follow‐up appointments and contact instructions was left for an additional 142 patients (15%). In total the nurses intervened on 454 issues on 316 patients (45%). Of the 158 patients (23%) with questions regarding discharge instructions, nurses clarified general discharge instructions for 26 patients (16%) and medication instructions for 90 (57%), contacting a physician or pharmacist in the remaining 42 cases (27%). In 87 patients (12%) with new or ongoing symptoms, nurses were able to independently triage 59 patients (67%) to home health providers, appointments with outpatient physicians and urgent/emergency care, contacting hospitalists for only 28 patients (32%). Other issues were resolved as described in Table 1.
TABLE 1 Areas of Nursing Intervention in Postdischarge Phone Calls
Conclusions:
The majority of issues surrounded follow‐up appointments, discharge and medication instructions, and symptom management. Nurses intervened frequently, independently managing the majority post‐discharge issues, with low rates of physician and pharmacist contact. Contrary to previous published reports, the need for more specialized providers was low. Nursing success at independently managing the majority of issues suggests that well‐resourced nurses can provide a wide range of postdischarge interventions and may be a cost‐effective alternative to more specialized providers.
Disclosures:
M. Mourad ‐ none; S. Rennke ‐ none; S. Kesh ‐ none; E. Kynoch ‐ none