Patient callbacks can decrease legal risks

The number one reason? A patient's life could be saved

During a telephone call to a congestive heart failure (CHF) patient who was discharged after an emergency department (ED) visit, it wasn't so much what the patient said that was alarming as how she sounded, reports Stephanie J. Baker, RN, MBA/HCM, CEN.

"She was very short of breath," she says. "I asked her to get on the scale and discovered she had gained four pounds in the last day."

Discharged CHF patients might not realize the importance of weighing themselves, being diligent about their salt intake, or taking their medications, says Baker, leader for Gulf Breeze, FL-based Studer Group's Emergency Services division.

During another call, Baker spoke to the roommate of a college student who had been discharged two days earlier with viral meningitis. She learned he was unresponsive.

"His labs were OK [upon discharge], but within the next 48 hours he developed meningococcal meningitis," she says. "The physician told me it was a good thing I had called, because he would have been dead by 5 p.m."

Baker has called thousands of patients post-discharge and discovered several times that a patient required immediate intervention.

"The number one reason we make calls is for quality and safety. If you do them long enough, you will save a life," she says.

ID at-risk patients

Of 400 hospitalized patients studied in 2003 by researchers at the University of Ottawa in Canada, 76 patients had adverse events after discharge, and of these, 23 had preventable adverse events.1 Studer Group recommends that 100% of patients discharged to home receive a post-visit phone call within 48 hours.

"In our experience, organizations that commit to post-visit phone calls typically experience a reduction in risk and liability rates," says Baker.

However, physicians can "start small" by calling patients at risk for rapid deterioration after they are discharged, says Baker, such as children under 2, patients over 75, or patients who had an invasive radiology procedure.

"Whether a sole provider, a physician office, or a multispecialty group, each practice should determine which patients are going to be called," she says. "Then track the results and link them to outcomes."

There are many recent peer-reviewed references that support patient re-contact after hospitalization or an ED visit, says Tom Scaletta, MD, FAAEM, chair of the emergency department at Edward Hospital in Naperville, IL.2,3,4

Cost is primary consideration

Scaletta says the main barrier to patient callback programs is their cost, which is up to $2.50 per case for outsourced callbacks and double that amount for nurse calls after a hospitalization. He is working to cut that cost in half by using email and texts messages.

"The costs are small relative to the return on investment, which includes reduced risk, improved satisfaction, and increased staff accountability," he says.

Scaletta implemented a patient callback program in 2004 in the ED at Edward Hospital & Health Services in Naperville, IL, to reduce the risk of negative outcomes following discharge.

"Promptly assessing patient well-being and uncovering concerns prevents claims," says Scaletta. "About six years ago, a major insurer offered my hospital a reduced rate, in part because of our callback program. We are now self-insured and always looking for ways to further improve patient safety."

References

  1. Forster, AJ, Murff HJ, Peterson JF, et al. The incidence and severity of adverse events affecting patients after discharge from the hospital. Annals Internal Med 2003; 138(3):161-174.
  2. Naffe A. Post-discharge follow up phone call. Heart & Lung (letter) 2012; 41:102.
  3. Weisman DS, Bashir L, Mehta A, et al. A medical resident post-discharge phone call study. Hosp Pract (Minneap). 2012; 40(2):138-146.
  4. Harrison PL Hara PA, Pope JE et al. The impact of post discharge telephonic follow-up on hospital readmissions. Popul Health Manag 2011; 14(1):27–32.

Sources/Resources

For more information on patient callback programs, contact:

  • Stephanie J. Baker, RN, MBA/HCM, CEN, Studer Group, Emergency Services Division, Gulf Breeze, FL. Email: stephanie.baker@studergroup.com.
  • Tom Scaletta, MD, FAAEM, Chair, Emergency Department, Edward Hospital, Naperville, IL. Phone: (630) 527-5025. E-mail: tscaletta@edward.org.
  • A white paper from Medical Insurance Exchange of CA recommends that a patient callback program be implemented. To read the entire white paper, go to http://www.miec.com. Click on "Resources," "Publications," and under "Specialty-Specific Handbooks," select "Reduce your Risks in the Emergency Department."
  • Studer Group's Alliance for Health Care Research published a review of studies on the benefits of hospital callbacks. To access the report, go to http://bit.ly/NMDlk1.