Postdischarge Phone Calls Research Articles

Exploring Healthcare Professional's Comfort Level And Self-assessed Competency On Providing Patient Care To Young Breast Cancer Patients

illustrated by a retrospective review of patient satisfaction results and by examining the number of re-scheduled and /or cancelled appointments. The PRPA is also used to educate and familiarize patients with the preparation required for CT Simulation and treatment delivery. Statistical analysis has shown a drastic reduction in prostate patients requiring re-scan due to unacceptable bladder and bowel preparation, as well as cancelled appointments, as patients arrive better prepared for their scans. Appointment times for CT Simulation have also been reduced as patients have been familiarized with the procedures in advance. A comparison of patient satisfaction data, obtained via post-discharge phone calls prior to and following the introduction of the PRPA role, has shown an improvement in the department’s ability to address patient needs in general. CCO has conducted patient satisfaction surveys which highlight strengths, opportunities for improvement, and overall quality of care in radiation therapy departments throughout Ontario. Results show that SRCC is rated highly, however, opportunities exist to better support patients emotionally by providing treatment-related information and facilitating referrals to social work and supportive/palliative care services. The PRPA role is uniquely situated to continue to positively influence the identified areas for improvement. Recommendations: The PRPA role provides an opportunity for improved patient-centered care. It empowers patients and their family members from the beginning, by offering support, information and alleviating anxiety which may be associated with the treatment process. The PRPA role also facilitates multi-disciplinary collaboration and increases recognition of radiation therapists as integral members of the professional team. Additionally, the role presents an opportunity for cost savings, as a greater number of patients could potentially be treated in the same period of time with reduced scanning times and fewer repeat scans being required.

Implementation of a Pre-Radiation Therapy Patient Assessment Role at the Stronach Regional Cancer Centre (SRCC)

Implementation of a Pre-Radiation Therapy Patient Assessment Role at the Stronach Regional Cancer Centre (SRCC)

Facilitating a Safe Transition From the Pediatric Emergency Department to Home With a Post-Discharge Phone Call: A Quality-Improvement Initiative to Improve Patient Safety

Facilitating a Safe Transition From the Pediatric Emergency Department to Home With a Post-Discharge Phone Call: A Quality-Improvement Initiative to Improve Patient Safety

Improving Transitions of Care From Hospital to Home: What Works?

As the cost of care rises and fragmentation of health care increases, care transitions have become critical parts of the health care system. Physicians and other inpatient providers have the responsibility to communicate to subsequent providers, but such communication occurs far less than is optimal. Timely discharge summaries for the next-level provider, postdischarge phone calls to patients, and postdischarge follow-up appointments with primary-care physicians or inpatient providers may improve postdischarge health care utilization. Pharmacists may also reduce medication errors, adverse medication events, and even readmissions. The most promising data, however, come from studies of multidisciplinary approaches, some of which have shown large reductions in postdischarge utilization and costs. More study is needed to pinpoint the most cost-effective and efficient strategies to improve transitions from the inpatient setting to other settings.

Abstract 294: Post-Discharge Phone Calls: Efficient Opportunity to Assess and Improve Patient Adherence to Care Plan

Background: Transitioning from hospital to home is a common failure point in care delivery and patient adherence to a plan of care. Our post-discharge phone calls helped identify gaps (especially related to medications) and assign accountability for addressing issues. Method: We reached more than 200 patients with Acute Coronary Syndrome and Congestive Heart Failure by phone 24-48 hours after discharge between 8/2011 - 1/2012. We tested two operating models: hospital nurse with knowledge of admission (n=200) vs. clinic nurse with ongoing responsibility for managing patient (n=10 and ongoing). Callers used a standardized script and documentation form with “teach-back” methodology. Outcomes (Figure): Medications issues (65%, 107 of 165) included errors in discharge meds lists that contributed to patient misunderstandings and lack of adherence. Most (63%, 89 of 142) patients left the hospital without a scheduled follow-up appointment (revealing systematic improvement need). Callers provided teaching and reinforcement and triaged issues, avoiding at least 3 - 4 probable readmissions. Comparing two delivery models (hospital vs. clinic nurse) yielded notable differences. For both groups, calls took ∼15+ minutes (min=6, max=48). However, prep time, documentation and follow-up were significantly longer for hospital nurses (35 mins) than clinic nurses (15 mins). The hospital nurse spent more time “mining” records to understand each patient story; clinic nurses could prioritize calls and personalize content based on prior relationships with patients. Issues were quickly handled by clinic nurses in face-to-face provider interactions, whereas the hospital nurse frequently became mired in lengthy back-and-forth clinical communication. Conclusion: Analysis of post-discharge phone calls shows that some patients (new diagnoses, complicated medications regimen) may particularly benefit; however, the call represented a valuable reinforcement opportunity for all patients we reached. Optimally efficient, effective calls require: 1) Reliable patient contact information; 2) Clear record of plan of care, including accurate medications list; 3) Follow-up appointments scheduled; 4) Caller expertise with diagnoses; and 5) Caller prior relationship with the patient. Going forward, our team will continue to test clinic-based post-discharge phone calls, evaluating several key metrics including ability of patients to successfully articulate their medications and follow-up plans, % of patients who attend their follow-up appointments, readmission rates, et al.

P100 Designing and implementing a COPD discharge care bundle

ProblemAcute exacerbations of COPD are a major cause of hospital admission and readmission. National surveys have revealed significant differences in patient outcomes which are likely to be due to variations...

Filling in the Lines: Historical Assessments and Their Prevention of Untoward Outcomes in the Day-Surgery Patient

THERE IS NO DOUBT in the minds of nurses who work in the ambulatory surgery setting that the more they know about their patients, the better equipped they are to care for and anticipate potential problems. The depth and breadth of that knowledge is provided by the astute assessment skills of the registered nurse (RN) throughout the continuum of care for the perianesthesia patient. This assessment begins in the preadmission/operative evaluation service and continues through the postdischarge follow-up phone calls. Understanding the impact of historical data on the current presentation of the patient provides the avenue for critical thinking and complex problem solving and mediates crisis management when a complication occurs. This two-part column will explore the historical assessment and its impact throughout the perianesthetic continuum of care. Case studies involving untoward outcomes will be reviewed regarding the impact of this historical assessment and its predictive value in managing the patient’s outcomes. Sarah M. Cartwright, BA, RN, CAPA, is a Charge Nurse, CNIV, for Preoperative Evaluation at MCGHealth, Augusta, GA.

Post‐hospitalization transitions: Examining the effects of timing of primary care provider follow‐up

The transition between the inpatient and outpatient setting is a high-risk period for patients. The presence and role of the primary care provider (PCP) is critical during this transition. This study evaluated characteristics and outcomes of discharged patients lacking timely PCP follow-up, defined as within 4 weeks of discharge. This prospective cohort enrolled 65 patients admitted to University of Colorado Hospital, an urban 425-bed tertiary care center. We collected patient demographics, diagnosis, payer source and PCP information. Post-discharge phone calls determined PCP follow-up and readmission status. Thirty-day readmission rate and hospital length of stay (LOS) were compared in patients with and without timely PCP follow-up. The rate of timely PCP follow-up was 49%. For a patient's same medical condition, the 30-day readmission rate was 12%. Patients lacking timely PCP follow-up were 10 times more likely to be readmitted (odds ratio [OR] = 9.9, P = 0.04): 21% in patients lacking timely PCP follow-up vs. 3% in patients with timely PCP follow-up, P = 0.03. Lack of insurance was associated with lower rates of timely PCP follow-up: 29% vs. 56% (P = 0.06), but did not independently increase readmission rate or LOS (OR = 1.0, P = 0.96). Index hospital LOS was longer in patients lacking timely PCP follow-up: 4.4 days vs. 6.3 days, P = 0.11. Many patients discharged from this large urban academic hospital lacked timely outpatient PCP follow-up resulting in higher rates of readmission and a non-significant trend toward longer hospital LOS. Effective transitioning of care for vulnerable patients may require timely PCP follow-up.