Abstract
BackgroundAfter hospital discharge, patients can experience symptoms prompting them to seek acute medical attention. Early evaluation of patients’ post-discharge symptoms by healthcare providers may improve appropriate healthcare utilization and patient safety. Post-discharge follow-up phone calls, which are used for routine transitional care in U.S. hospitals, serve as an important channel for provider-patient communication about symptoms. This study aimed to assess the facilitators and barriers to evaluating and triaging pain symptoms in cardiovascular patients through follow-up phone calls after their discharge from a large healthcare system in Central Massachusetts. We also discuss strategies that may help address the identified barriers.MethodsGuided by the Practical, Robust, Implementation and Sustainability Model (PRISM), we completed semi-structured interviews with 7 nurses and 16 patients in 2020. Selected nurses conducted (or supervised) post-discharge follow-up calls on behalf of 5 clinical teams (2 primary care; 3 cardiology). We used thematic analysis to identify themes from interviews and mapped them to the domains of the PRISM model.ResultsParticipants described common facilitators and barriers related to the four domains of PRISM: Intervention (I), Recipients (R), Implementation and Sustainability Infrastructure (ISI), and External Environment (EE). Facilitators include: (1) patients being willing to receive provider follow-up (R); (2) nurses experienced in symptom assessment (R); (3) good care coordination within individual clinical teams (R); (4) electronic health record system and call templates to support follow-up calls (ISI); and (5) national and institutional policies to support post-discharge follow-up (EE). Barriers include: (1) limitations of conducting symptom assessment by provider-initiated follow-up calls (I); (2) difficulty connecting patients and providers in a timely manner (R); (3) suboptimal coordination for transitional care among primary care and cardiology providers (R); and (4) lack of emphasis on post-discharge follow-up call reimbursement among cardiology clinics (EE). Specific barriers for pain assessment include: (1) concerns with pain medication misuse (R); and (2) no standardized pain assessment and triage protocol (ISI).ConclusionsStrategies to empower patients, facilitate timely patient-provider communication, and support care coordination regarding pain evaluation and treatment may reduce the barriers and improve processes and outcomes of pain assessment and triage.
Highlights
After hospital discharge, patients can experience symptoms prompting them to seek acute medical attention
We focused on pain assessment for two reasons
Using information from electronic health records (EHRs), we identified adult patients (> 18 years old) who satisfied the following conditions: (1) had index hospitalization with diagnoses compatible with acute coronary syndromes or heart failure between November 2018 and November 2019; (2) had emergency department (ED) visits or rehospitalizations within 30 days postdischarge; and (3) reported pain between index hospitalization and readmission to acute care services
Summary
Patients can experience symptoms prompting them to seek acute medical attention. Patients often experience symptoms that prompt them to seek acute medical attention [2,3,4,5,6] These symptoms included warning symptoms related to patients’ heart conditions, and new symptoms or exacerbations of chronic problems that could be managed in primary care [2,3,4,5,6]. The former may represent an appropriate, and at times unavoidable, reason for repeat visit to acute care; while the latter might be prevented by close follow-up assessment, management, and health coaching [3,4,5,6]
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