Follow-up system aims to improve patient safety

80% called unclear about follow-up appointment

A study by Irvine, CA-based Cogent Healthcare Inc. has confirmed what many case managers know instinctively: Following discharge from the hospital, many patients are confused about their medication, their discharge instructions, and when to follow up with their primary care physicians.

Among the patients who were contacted by the company’s "homecoming callers," 80% were unclear about their follow-up appointment, and 20% had issues such as questions about their medication or durable medical equipment that had not been delivered, according to Navneet Kathuria, MD, MPH, national medical director for Cogent, an inpatient care management company.

About 7% reported having symptoms that staff at Cogent’s call center determined should be discussed with a physician or nurse.

"The continuum of care doesn’t end when a patient walks out of the hospital. Patients are often still sick when they leave the hospital. They are confused and need to talk to someone but are reluctant to call their physician," Kathuria says.

The patient discharge follow-up program is part of Cogent’s program to provide a comprehensive hospitalist program on a contract basis to hospitals.

"We needed a program to make sure patients upon discharge from the hospital were getting appropriate follow-up," he says.

Just faxing information to the patient’s primary care physician was not enough, he adds.

"We felt that we needed to follow up with the patients to make sure that once they got home, they had what they needed so they didn’t end up back in the emergency room or visiting their primary care physician within a few days after discharge," he says.

Their solution was to set up a homecoming calling system that would follow patients after discharge.

The discharging physician dictates patient information, which is transcribed into a database. The information includes the admissions diagnosis, the discharge diagnosis, discharge instructions, medication and dosage, any critical labs, recommended follow-up visits, and any kind of home care ordered for the patient.

At Cogent’s call center, trained callers, supervised by registered nurses, call patients within 48 hours of discharge. Only patients discharged to independent living situations receive phone calls.

The "homecoming callers," as Cogent calls them, have a set of questions to ask the patients. Among them: How are your feeling? Do you have any symptoms? Do you have medication? Do you know when your next appointment is with your primary care physicians?

Preventing returns to the hospital

In some instances, durable medical equipment or home oxygen was ordered for the patient but the company didn’t deliver it.

"We can follow up and make sure it’s delivered, as opposed to having the patient end up in the emergency room," he says.

Every patient who is seen in the hospital by a Cogent hospitalist is put into the system to receive the follow-up telephone calls. The callers are able to connect with about 65% of them after two attempts.

"We believe that the follow-up calls prevent unnecessary visits to the emergency room, readmissions to the hospital, and have an impact on the overall health of the patient," Kathuria says.

Often, the patients have information about how often to take their medicine or what time of day they should take it.

If there are issues such as not getting a prescription, side effects from the medicine, or symptoms that could signify a problem, the homecoming callers get in touch with the hospitalist or the clinical care coordinator and ask them to make sure the problem is addressed.

Cogent’s hospitalist program is staffed by physicians specializing in hospital care and clinical care coordinators who are registered nurses or nurse practitioners to work with the physicians.

The clinical care coordinators work with the physicians in the hospital, handling paperwork and making sure patients gets what they need and that tests and treatments are done in a timely manner. "They work with the staff in the hospital. They don’t take on the task of the hospital case managers, and they make sure they don’t step on the hospital staff’s toes," he says.

When Cogent established its hospitalist program, it did a time analysis of the physician’s day.

"They were doing a lot of paperwork, including filling out forms and getting information from the specialists or primary care physician. We hired the clinical care coordinators to assist in the process," he says.

The program will help the company determine what actually goes on with patients after discharge.

"Until they visit their primary care physician, no one actually knows what is going on. We now have a process in place to track this information and address any concerns the patient may have," he says.