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Stop needless ED visits with smart discharge
You gave your patient thorough discharge instructions, verbal and written, but are you sure he or she really understands them?
Some patients return to the ED because they don't have a clear understanding of discharge instructions or the next steps for follow up, says Carrie L. Baumann, RN, BSN, patient care supervisor in the Emergency Department Trauma Center at Children's Hospital of Wisconsin.
"Wrong dosages of medication and schedules aren't maintained, due to the patient not listening to instructions or throwing out written instructions," says Baumann.
To avoid needless repeat visits, she says to do the following:
Make an effort to provide patients with a primary care provider.
Most of Children's Hospital of Wisconsin's ED pediatric population doesn't have a primary care provider. "We need to be diligent with giving them the contacts, so that they are able to find someone that fits their needs and expectations," says Baumann.
Sit down with patients and thoroughly read through the instructions.
When you are finished, Baumann says to ask your patient, "What can I answer for you at this time?" and "Is there anything you need from us at this time?"
"Repeat, repeat, repeat," says Baumann. "Ask for verbalization of the medication schedule, dosage, and what it is for. Go through the teaching sheets with them, in case there is verbiage or concepts that are not understood. "
Track previous visits.
Children's Hospital's ED nurses can access the Wisconsin Information Exchange. "If the patient has been seen at other EDs in the city, we are able to track where they have been," says Baumann. "We can then coordinate with the other ED if there is a pattern, or any missing information."
Address the needs of patients with chronic conditions such as sickle cell or asthma.
"We need to ensure that the plan at discharge is discussed and that all information is given to their primary care provider," Baumann says. "If the instructions are clear at discharge and information is readily accessible, there are markedly fewer visits by chronic patients."
Patients are contacted post-discharge.
"Our outreach nurse attempts to contact all individuals seen in our ED on a daily basis," says Baumann. "Even the most benign visits are called back."
The nurse asks if follow-up appointments are scheduled, checks acetaminophen or ibuprofen dosages if fever is continuing, calls in forgotten prescriptions, calls for lab reports, and changes prescriptions if needed. "This decreases repeat visits. It has a huge impact on the patient and family," says Baumann. "It allows them to ask the questions they were too overwhelmed to ask at the time in the ED."
Give 'fever packets' to frequent patients
Kevin Perry, RN, ED nurse at Providence St. Vincent Medical Center in Portland, OR, gives the example of a young child who is brought in "for the umpteenth time, for a simple fever or cold. How many of these visits could be prevented with proper fever management teaching?"
St. Vincent's nurses developed "fever packets." These are given to children under 16 with fever as part of their discharge plan. "This program empowers those parents to care for their child's simple fevers at home. It thereby prevents unnecessary ER visits," says Perry. Each packet includes:
"A research study is currently under way to evaluate the effect these packets have had," reports Perry. "Data is still being collected. However, the initial results are encouraging." (For more information, contact Perry at Kevin.Perry@providence.org. The "fever packets" are included.)