Su1429 INCREASED CAPTURE OF POST-ERCP ADVERSE EVENTS BY DELAYED (DAY 7) FOLLOW-UP CALLS: A PROSPECTIVE COMPARISON OF PHYSICIAN AND NURSE-INITIATED CALLS

Abstract

ERCP is a high-risk endoscopic procedure, but reports of ERCP-related complications are largely based on immediate post-procedure assessment. Some institutions call patients the day after ERCP, but these calls reach as few as 20% of patients. Based on population-level studies demonstrating a >10% rate of unplanned healthcare encounters (UHE) in the 30 days following ERCP, we hypothesized that immediate assessment and day 1 follow-up calls underestimate the true adverse event rate; follow-up calls on day 7 may increase capture and allow a more accurate assessment of adverse event rates. We prospectively evaluated follow up calls on day 1 & day 7 post ERCP and also compared nurse-initiated with physician-initiated calls to assess the impact of transitioning this responsibility to a nurse. This prospective study was conducted on consecutive patients undergoing ERCP at our tertiary care academic medical center from March-October 2019. Patients were encouraged to contact us with post-procedure symptoms. Additionally, patients received phone calls at day 1 and 7 post-ERCP by either an endoscopist or a nurse coordinator using a standardized script to assess for delayed complications (pancreatitis, non-pancreatitis abdominal pain, bleeding, infection, perforation) and UHE [hospitalizations, clinic/urgent care/emergency department (ED) visits)]. 448 ERCP patients (239 physician calls, 209 nursing calls) were included in this study. Physician calls were more successful than nursing calls in reaching patients at both day 1 (96% v 74%, p<0.01) and at day 7 (91% v 63%, p<0.01, Figure 1). Nursing calls were significantly longer than physician calls on both days (p<0.001). The assessed overall adverse event rate was 1.7% upon immediate post-procedure evaluation. Increased detection of complications was accomplished by both physician and nurse calls at day 7 compared to day 1 (p<0.01, Figure 2). A higher adverse event capture rate by physician calls compared to nursing calls was evident on day 1 (3.5% vs. 2.4%, p=0.04) and day 7 (10.6% vs. 6.3%, p<0.01). In addition to patient-initiated UHEs that had already occurred prior to our call, physician day 7 follow-up calls resulted in substantially more patients triaged to the ED, primary care and oncology clinics than nursing calls (p<0.001). 1. Day 1 and day 7 calls increased capture of adverse events relative to immediate post-ERCP assessment, with both physician and nurse-initiated day 7 calls having a 3-fold higher capture of adverse events relative to day 1 calls.