321 Social Resources during Emergency Department Discharges: The Impact of a Volunteer Patient Discharge Initiative on Emergency Department Revisits

Abstract

The objective of this study was to examine the rates of emergency department (ED) revisits and outpatient follow-up of patients receiving the Patient Discharge Initiative (PDI) intervention of social and community resources upon discharge from the ED. The PDI, a volunteer organization aimed at improving health outcomes, is based at Ben Taub Hospital, a public, urban hospital in Houston with approximately 89,000 emergency center patient visits annually. PDI volunteers approached patients prior to discharge and provided educational interventions including connection to social and medical resources such as transportation, low-cost dental services, financial assistance services, and housing services. A post-ED follow-up telephone call was conducted 30 to 90 days after the ED visit. We retrospectively reviewed written records of interventions between September 1, 2017 and May 1, 2018. We also examined the patient’s corresponding electronic medical record to obtain additional demographic data, ED visit chief complaint, and follow-up and ED revisit rates. A total of 494 patient encounters were included in the data analysis. The majority of patients were female (55.2%). The population was majority Latino/Hispanic (55.3%), followed by African American (30.6%), and Caucasian (9.72%). Over one third (35.2%) of all patients self-reported as Spanish-speaking only. Most patients (50.2%) received health care cost financial assistance through a local governmental program, 16.6% of patients had private or public insurance coverage, and 33.2% were uninsured. A majority (53.2%) had post-ED follow-up appointments scheduled. A majority of patients (83.6%) requested at least one medical-related or social resource at discharge, with the most common being information on low-cost dental services (43.3%) and services to assist with paying bills (12.3%), respectively. Of the patients contacted by volunteers in a post-ED follow-up telephone call, 51.2% reported successfully utilizing a resource received from the intervention. These patients had significantly lower ED revisit rates within 90 days of the initial ED discharge compared to those who did not receive a follow-up call (13.5% vs 25%, respectively; p = 0.028); however, there was no difference in follow-up appointment attendance rates between the two groups (65.9% vs 63.4%, respectively). These data demonstrate the potential for an ED discharge intervention focused on providing underserved patients with social resources.