Utilizing Patient-Initiated Call Program to Assist with Self-Care in Pediatric Patients after Hospital Discharge

Description: Discharge follow-up contact helps reduce readmissions and returns to the emergency department. Post-discharge follow-up phone calls may not meet patients’ needs if unavailable or questions arise after the call. Our organization didn’t have a dedicated 24/7 nurse to contact for clarification of discharge instructions. The discharge after-visit summary (AVS) included a follow-up appointment with the patient’s primary care provider or subspecialist but listed the main hospital phone number. Hospital operators transferred calls to the nursing unit where the patient was most recently admitted. When the patient called the primary care provider, they often referred the patient to the ED for questions related to a recent hospitalization. We looked for a technology solution that could assist and engage families post-discharge. The purpose of this EBP project is to determine if patient-initiated calls to experienced nurses in a centralized call center can identify barriers and assist with self-management at home within 72 hours of discharge.
Methods: A technology solution was implemented in January 2021 to engage patients post-discharge along with the nurse advice line (NAL) phone number included on the AVS, with 24/7 access to an experienced nurse immediately after discharge. A standardized texting script, comprised of seven discharge-related questions, was programmed into the text messaging technology. When a parent replies to a question that indicates help is needed, a number is displayed connecting the family to a nurse in real time. The unique phone number indicates to the nurse that this is a recently discharged patient. The nurse receives a best practice alert that the patient was discharged within the last 72 hours to reduce the chance of missing a recently discharged patient.
Analysis: Calls were placed into categories related to the purpose of the call. The total number of calls was calculated and the percentage of calls for each category was determined. The reason for calls at the beginning of the project was compared to data collected one year later. Patient care units and inpatient stays were compared.
Results: After one year, a total of 228 calls were received averaging 19 calls per month. In the first 24 hours, 118 (52%) of calls occurred. Respiratory calls increased and were the highest percentage (35%), mostly in the first 24 hours -19. Many ENT and endocrine calls occurred. ENT and endocrine clinics were engaged and met with the nurse advice line to discuss calls and improve processes. Endocrine concerns decreased from 20% to 8% of calls. ENT calls decreased from 13% to 9%. Calls in which patients were sent to the ED and readmitted were 31 of 61 calls (51%). Four of those readmissions went to the PICU. Patient units, observation, and inpatient stays were compared and showed no significant difference. One year later this program is a safety net for discharged patients to receive proactive care. The program evolved to transfer calls to the post-discharge care managers during daytime hours, but new or worsening symptoms are transferred to the nurse advice line maintaining 24/7 coverage.