scholarly journals Nurse-Led Call Back Program to Improve Patient Follow-Up With Providers After Discharge From the Emergency Department

2020 ◽  
Vol 7 (6) ◽  
pp. 1349-1356
Author(s):  
Ines Luciani-McGillivray ◽  
Julie Cushing ◽  
Rebecca Klug ◽  
Hang Lee ◽  
Jennifer E Cahill
Keyword(s):  
Emergency Department ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Patient Compliance ◽  
Phone Call ◽  
Discharge Instructions ◽  
Phone Calls ◽  
Improve Patient ◽  
Hospital Volunteers

Phone calls to patients after discharge from the emergency department (ED) serve as reminders to schedule medical follow-up, support adherence to discharge instructions, and reduce revisits to already-crowded EDs. An existing, nurse-administered, call-back program contacted randomly selected ED patients 24 to 48 hours following discharge. This program did not improve patient follow-up (48.68%) nor reduce the ED revisit rate (6.7% baseline vs 6.0% postimplementation). Plan-Do-Study-Act methodology tested a modification to the existing program consisting of a second, scripted phone call from a trained volunteer at 72 to 96 hours postdischarge. Volunteers utilized a patient list and script, and nurses provided expertise to eliminate identified barriers to follow-up. Follow-up rate and ED revisit were monitored through the electronic medical record. A total of 894 patients participated between October 2017 and June 2018. Follow-up increased from 48.68% to 65.5% ( P < .0001) and ED revisit decreased significantly (4.5% vs 8.6%, P < .001). This innovative nurse-led, systematic postdischarge call-back program utilizing hospital volunteers increased patient compliance with post-ED medical follow-up while significantly reducing the rate of patient revisit to the ED within 7 days of discharge.

Follow-up Phone Calls After an Emergency Department Visit

PEDIATRICS ◽  
1994 ◽  
Vol 93 (3) ◽  
pp. 513-514 ◽  
Author(s):  
Vidya T. Chande ◽  
Vanessa Exum
Keyword(s):  
Emergency Department ◽  
Pediatric Emergency ◽  
Severe Illness ◽  
Improve Patient Compliance ◽  
Discharge Instructions ◽  
Parental Compliance ◽  
Phone Calls ◽  
Viral Illness ◽  
Improve Patient

Follow-up care of patients treated in an emergency department (ED) is an important component of patient care. Previous studies suggest that follow-up phone calls may improve patient compliance with discharge instructions.1-4 Most of these studies have used nurses to contact the families of children with relatively mild illnesses, such as otitis media or nonspecific viral illness. The families who received follow-up phone calls were more likely to keep their scheduled follow-up appointments than those who did not. We studied patients discharged from the Pediatric Emergency Department (PED) with moderate to severe illness for whom close follow-up is essential. We hypothesized that physician-initiated follow-up phone calls to parents of moderately ill children seen in the PED would improve parental compliance with primary care follow-up.

scholarly journals 688 Rapid Implementation of Virtual Fracture Clinic During COVID 19 Reduces Both Face-To-Face Appointments and Facilitates Rapid Feedback and Education to Be Delivered to The Emergency Department

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
T Havenhand ◽  
L Hoggett ◽  
A Bhutta
Keyword(s):  
Emergency Department ◽  
Patient Flow ◽  
Prospective Data ◽  
Fracture Clinic ◽  
Face To Face ◽  
Return Rates ◽  
Acute Hospitals ◽  
Virtual Fracture Clinic ◽  
Improve Patient

Abstract Introduction COVID-19 has dictated a shift towards virtual clinics. Pennine Acute Hospitals NHS Trust serves over a million patients with a significant number of face-to-face fracture clinics. Introduction of a Virtual Fracture Clinic (VFC) reduces hospital return rates and improves patient experience. The referral data can be used to give immediate monthly feedback to the referring department to further improving patient flow. Method Prospective data was collected for all referrals to VFC during March 2020. Data included referral diagnosis, actual diagnosis, referrers grade, and final outcome. Results 630 referrals were made to VFC. 347 (55%) of those referrals were directly discharged without the need for physical consultation. Of these 114 (32%) were injuries which can be discharged by the Emergency Department with an advice leaflet using existing pathways. Of the remaining discharges 102 (29%) were query fractures or sprains; and 135 (39%) were minor fractures; which needed only advice via a letter and no face to face follow up. Conclusions Implementation of VFC leads to a decrease in physical appointments by 55% saving 347 face to face appointments. The new system has also facilitated effective audit of referrals in order to further improve patient flow from the Emergency Department via feedback mechanisms and education.

scholarly journals Doctors documenting: an ethnographic and informatics approach to understanding attending physician documentation in the pediatric emergency department

2020 ◽  
Author(s):  
Sarah D Fouquet ◽  
Laura Fitzmaurice ◽  
Y Raymond Chan ◽  
Evan M Palmer
Keyword(s):  
Emergency Department ◽  
Mixed Methods ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Pediatric Emergency ◽  
Second Phase ◽  
Pediatric Emergency Department ◽  
Mixed Methods Approach ◽  
Time And Motion ◽  
Attending Physician

Abstract Objective The pediatric emergency department is a highly complex and evolving environment. Despite the fact that physicians spend a majority of their time on documentation, little research has examined the role of documentation in provider workflow. The aim of this study is to examine the task of attending physician documentation workflow using a mixed-methods approach including focused ethnography, informatics, and the Systems Engineering Initiative for Patient Safety (SEIPS) model as a theoretical framework. Materials and Methods In a 2-part study, we conducted a hierarchical task analysis of patient flow, followed by a survey of documenting ED providers. The second phase of the study included focused ethnographic observations of ED attendings which included measuring interruptions, time and motion, documentation locations, and qualitative field notes. This was followed by analysis of documentation data from the electronic medical record system. Results Overall attending physicians reported low ratings of documentation satisfaction; satisfaction after each shift was associated with busyness and resident completion. Documentation occurred primarily in the provider workrooms, however strategies such as bedside documentation, dictation, and multitasking with residents were observed. Residents interrupted attendings more often but also completed more documentation actions in the electronic medical record. Discussion Our findings demonstrate that complex work processes such as documentation, cannot be measured with 1 single data point or statistical analysis but rather a combination of data gathered from observations, surveys, comments, and thematic analyses. Conclusion Utilizing a sociotechnical systems framework and a mixed-methods approach, this study provides a holistic picture of documentation workflow. This approach provides a valuable foundation not only for researchers approaching complex healthcare systems but also for hospitals who are considering implementing large health information technology projects.

Abstract T MP103: Effect of Follow-up Phone Calls on 30-day Readmission Rates for Stroke Patients

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Kelly Anderson
Keyword(s):  
Intervention Group ◽  
Signs And Symptoms ◽  
Lifestyle Changes ◽  
Phone Call ◽  
Control Group ◽  
Readmission Rates ◽  
Convenience Sample ◽  
Phone Calls ◽  
Number Of Patients

Background and Purpose: Patients who are hospitalized for a stroke or TIA go home with a great deal of information about risk factors, medications, diet and exercise, signs and symptoms of stroke and follow-up care. This information may be difficult for the patient or caregiver to understand and can be overwhelming in the face of a new life-changing event. In addition, The Centers for Medicare and Medicaid Services will start publicly reporting 30-day readmission rates beginning in 2016. The purpose of this study is to determine if follow-up phone calls with a nurse help to reduce 30 day readmission rates for patients with stroke and TIA. Methods: This study utilized a convenience sample of adult patients who were admitted for ischemic stroke, ICH, SAH or TIA from March 2013 to February 2014. Patients in the intervention group participated in a phone call seven days after discharge to assess their compliance with medications, physician appointments and lifestyle changes. The proportion of readmissions between the groups was compared with Fisher’s exact test. Results: The total number of patients enrolled in the study was 586 and there were no significant differences in demographics between the control and intervention groups. Of the 533 patients in the control group, 54 (10%) of them were readmitted, including 11 patients readmitted for elective surgical procedures. Of the 52 patients in the intervention group, 3 (5.7%) of them were readmitted before the 7-day phone call. Of the 49 patients who participated in the 7-day phone call, none of them were readmitted ( p =0.0098). Conclusions: Patients who participate in a 7-day phone call appear to benefit and are less likely to be readmitted to the hospital. Other strategies may need to be considered for patients who are at higher risk, and thus more likely to be readmitted within seven days of discharge. In addition, some providers may wish to reconsider how they schedule elective procedures for secondary stroke prevention.

scholarly journals Evaluation of Electronic Medical Record Downtime in a Busy Emergency Department

2020 ◽  
Vol 2020 (1) ◽  
Author(s):  
Dominic Jenkins ◽  
Raheel Sharfeen Qureshi ◽  
Jibin Moinudheen ◽  
Sameer A. Pathan ◽  
Stephen H. Thomas
Keyword(s):  
Emergency Department ◽  
Medical Record ◽  
Electronic Medical Record
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