Posthospitalization Follow-up: Always Needed or As Needed?

Abstract

A 4-year-old child is being discharged after a 3-day hospitalization for pneumonia that included treatment with supplemental oxygen and antibiotic therapy. The hospitalist instructs the child’s mother to schedule a follow-up appointment with the child’s primary care provider (PCP) within the coming week. The mother makes an appointment and calls her manager at work to ask if she can miss part of work that day for the appointment. Her manager mentions that she has already missed several days of work recently (related to the child’s medical care) but ultimately grants her the additional time away. Within 2 days of hospital discharge, the mother notes that the child seems to have recovered from her illness and is back to her normal self. Nevertheless, she takes the child to her follow-up appointment because that was the recommendation provided by the hospitalist. The child’s PCP concurs with the mother’s assessment that the child appears to have completely recovered from the illness. The mother appreciates the reassurance from the child’s PCP but also wonders if the visit, the co-pay, and the time away from work were really necessary. Most hospitalized children are prescribed automatic posthospitalization follow-up, that is, they are routinely instructed to visit their PCP shortly after hospital discharge, regardless of symptom improvement. For example, one multicenter study of 198 children hospitalized for bronchiolitis revealed that 84% of parents were given instructions for automatic follow-up.1 The high rate of automatic follow-up recommendations is perhaps unsurprising given that automatic follow-up is considered the standard of care2 and has been proposed (and implemented by at least 1 hospital3) as a quality metric.4 The intuitive appeal of automatic …