Post discharge phone calls improve care coordination Paula Anton, MS, RN, CRRN, ACNS-BC, Michelle Fernamberg, BSN, MHA, RN, CRRN, Erica Duchnowski, Health Care Administration Intern, Eastern Michigan University 6A Acute Rehabilitation Nursing, University of Michigan, Ann Arbor, MI.
Post discharge phone calls improve care coordination
Paula Anton, MS, RN, CRRN, ACNS-BC, Michelle Fernamberg, BSN, MHA, RN, CRRN,
Erica Duchnowski, Health Care Administration Intern, Eastern Michigan University
6A Acute Rehabilitation Nursing, University of Michigan, Ann Arbor, MI
Conclusion / Implications
Initially, the most concerning response from patients was that they did not have a post-discharge medical appointment. Clinic managers were engaged and a process was developed to solve thisquickly.
It is known that patient care does not end at discharge. There is growing demand that hospitals ensure that patients’ transition to home is smooth from a comfort standpoint, is medically sound, comprehensive and understandable. Follow-up telephone calls shorty after discharge is an effective strategy to accomplish this goal.1, 2These calls allow providers to impact patient satisfaction, decrease readmissions, verify effectiveness of discharge education and the discharge plan, and perform service recovery at a particularly vulnerable time for patients.1,2
Management commitment and engagement in the process is the key to success.
Overall, this strategy is an excellent way to evaluate and determine effectiveness of discharge processes at University of Michigan Hospital.
A pilot was conducted from May thru December of 2010 in which a Health Care Administration Intern and the Nurse Manager contacted each patient within 48 hours of discharge. A tool was developed to assist the caller to ask standard questions that elicited the information necessary to assess effectiveness of discharge. During the calls the caller would gather information to rectify problems and apologize for any problems experienced. Feedback was provided to the whole rehabilitation team including nurses, physicians, therapists and managers in real time.
Results of calls were tabulated and Root Cause Analysis (RCA) of comments was completed.
The RCA provides evidence that there continues to be opportunities for improvement.
Next Step is to consider the RCA and to look for opportunities to develop processes to address issues.
In Physical Medicine and Rehabilitation it was becoming evident that patients were dissatisfied with some aspects of their care. They were being discharged from the inpatient setting without follow-up regarding discharge education and plans. Complaints were common. Physician comments and calls from patients after discharge with questions provided doubts that the transition to home was smooth.
Additionally, the typical post-hospitalization patient satisfaction survey is not obtained from patients discharged from the Acute Rehabilitation Unit. This limits data that can be used to drive vital changes. Complaints and frustration expressed in phone calls from patients and families and at the time of clinic appointments were common among patients who left the Acute Rehabilitation Unit.
Outcomes measured include patient satisfaction with overall care, willingness to recommend and instructions for self care from discharge cards at time of discharge. In addition, patient comments regarding understanding of instructions, whether prescriptions and supplies were received and whether they had follow-up appointments obtained during the phone calls was analyzed. We found steady improvement in patient satisfaction over time, and improvement in most measures of smooth discharge.
Braun, E., Baidusi, A, Alroy, G., & Azzam, ZS. (2009). Telephone follow-up improves patients satisfaction following hospital discharge. European Journal of Internal Medicine, 20(2), 221-5.
Setia, N., & Meade, C. (2009). Bundling the value of discharge telephone calls and leader rounding. Journal of Nursing Administration. 39(3), 138-41.