423 Identifying Burn Patient Challenges with Implementation of Follow-Up Phone calls

Abstract

After hospitalization, some burn patients find the transition to the outpatient setting to be challenging. Patients are sometimes overwhelmed by discharge instructions and can miss many important details. As a result, some patients have experienced graft failure or infection due to poor wound care, ineffective pain control, or inadequate out-patient services. We have implemented follow-up phone calls to all discharged patients to attempt to improve patient outcomes. The pilot study of follow-up phone calls ran for four months. During this time, every patient seen or discharged from the Burn Center received a phone call from the assistant nurse manager within a week of discharge. Topics for the phone call included: general well-being, dressing changes, understanding of discharge instructions, medication, ancillary services including skilled nursing and occupational and physical therapy, and assistance with follow-up appointments. The need for and type of intervention subsequently undertaken was recorded. Fifty-two patients were included in this study, 21 (40%) of whom required intervention. Six (11.5%) had VNA that did not arrive or VNA nurses who were uncomfortable caring for the patient’s wounds. Nine (17.3%) needed interventions with either dressings or prescribed medications. Ten (19.2%) had either expedited wound center visits or new appointments made due to pain or infection risk. Despite detailed written discharge instructions and verbal review of those instructions prior to discharge, patients often require further assistance to obtain optimal care when they leave the hospital. By implementing routine follow-up telephone calls with discharged patients, we were able to identify patients requiring assistance. These included issues such as making post-discharge appointments, arrangements for services (skilled nursing visits; occupational and physical therapy), and the need for medication adjustment. This intervention also assisted with early detection of patients who had difficulty with dressing changes and showed signs of infection or graft failure, and expedited follow-up care in the outpatient setting. We conclude that the follow-up phone calls helped to identify and address challenges that arise for a significant number (40%) of patients and families when being discharged to home. Continuing research will determine if follow-up phone calls help prevent readmission rate and infection rates post-burn. Early identification of potential issues that may complicate the patient’s both short and long term outcome. Evaluating the relevance of patient challenges will improve patient outcomes.