final leadership project
TRANSCRIPT
5 East Post-Discharge
Follow-up Phone Call
Policy By Dallas Fisher
The Problem
In 2013, 23% of 5 East visits were
readmissions
66% of readmissions were within
30 days
21% of inpatient visits returned to
ED
Some as early as 1 day post-
discharge
563 ED visits total after discharge
908 ED visits total for 2013
Patients are having difficulty
transitioning from hospital to home
Research: Aftercare Utilization, ED
Visits & Readmission Data Average rate of utilization of aftercare
is 50%
Compliance with routine aftercare seldom exceeds 40%
Only 25-50% of patients attend outpatient appointment within 1st month of suicide attempt
Readmission rates range from 15%-46%
Over half of patients who were rehospitilized did not visit outpatient clinic between 2 admissions
Proportion of adherent patient to aftercare range from 21%-76%
Mean 5.03 ED visits/pt/year
Indication that large numbers of psychiatric patients do not receive aftercare in the community during the period immediately following hospital discharge
Research: Post-discharge Risk
Assessment Time immediately after discharge is
considered a critical period
Rates of medication non-adherence
Risk of relapse
Majority of post-hospitalization suicides occur during the 1st month after discharge with the peak of suicides occurring within a week
Risk for repeat attempts for suicidal patients is as high as 25%
Many psychiatric patients are not found to be at high or immediate risk for self-harm or relapse during their last contact with mental health providers
Research: Why Risks are
Increased Post-discharge Reduction in clinical supervision and
appropriate levels of support following hospitalization increase risks of:
Relapse
Self-harm
Aftercare and medication nonadherence
Readmission
Unecessary ED visits
Post-discharge follow-up phone calls can
Provide an opportunity to answer questions about care
Encourage aftercare participation
Detect any potential problems a patient may be facing during transition from hospital to home
Improve patient safety
Purpose of Follow-up Phone
Calls Post-discharge Smoothen the transition from
inpatient to outpatient care
Improve medication and aftercare adherence
Prevent hospitalization
Save costs
Improve patient outcome
Additional step to show we care about the patient’s outcome after they leave the hospital
Script
Script
Script
Length of Time Calls Should Take
and when Post-discharge The time immediately after discharge is a critical period
Nearly 1/3rd of readmissions occur within a week of discharge
Ability to reach a discharged patient quickly is paramount to the overall success of follow-up phone calls
Large proportion of post-discharge problems relate to informational needs
Early post-discharge contact provide opportunities
To address communication
Continuity gaps
Improve patient safety
Calls should be conducted 2-5 days after discharge and there will be two call attempts per patient
Allows flexibility for the nurse conducting the call depending on time constraints and amount of patients needing to be called
Calls will take about 5 minutes, but may average up to 10 minutes including dialing and multiple call attempts
Approximately 46% of patients are successfully contacted
That would be 46 patients/month equating to 460 minutes a month
That’s only an average of 15 minutes per day
Potential Hospital Savings
Hospital cost per visit for psychiatric disorders or chemical dependency readmission ≤ 30 days = $7,519
Total visits in 2013 on 5 East: 1,239
Average 100 visits/30 days
189 visits were within 30 days
189 ÷ 1,239 = 15% of total visits were within 30 days
15% of 100 visits = 15 visits/30 days
15 visits × $7,519 = $112,785 hospital costs/30 days
$112,785 × 12 months = $1,353,420 hospital costs/year
23.1% less likely to be readmitted if receive post-discharge telephone call
$1,353,420 × .231 = $312,640 hospital savings/year
On average 46% of discharged patients complete a call
$312,640 × .46 = $143,814 in savings yearly
Potential Hospital Costs
Average 5 East nursing wage: $49.50/hr
$0.825/min
10 minute average/phone call
10 min × 46 pts/month = 460 minutes/month
460 minutes ÷ $0.825 = $379.5/month
$379.5 × 12 months = $4,554/year
Spending $4,554/year could potentially
save the hospital $143,814 per year
Follow-up phone calls are a cost-effective
way to improve the quality of patient care
Desired Outcomes of Follow-up
Phone Calls Improve quality of care, promote health, and
reduce costs by helping individuals with mental illness
Adhere to their care plans
Obtain appropriate standard care
Engage in self-management of their recovery
Proportion of adherent patients to aftercare will increase from 21%-76% up to 46%-95%
Medication adherence for 3 consecutive months will increase from 36% to 59%
Reduction of readmissions and unnecessary ED visits
Decrease the likelihood of readmission by 23.1%
Readmission rates will decline from 15%-46% down to 7%-25%
ED visits will decrease from 5.03 visits/patient/year to 1.11 visits/patient/year
Evaluation of Follow-up Phone Calls
What Still Needs to be Done
ISD needs to be contacted to change case management discharge form in CPOE
Include area for phone number and whether they consent to being contacted after they are discharged
Make any additional changes to script
Then get familiar with script
Discuss a plan that works best for everyone on how to organize discharge paperwork and a way to determine who has been called and who needs to be called
Have a basic protocol regarding follow-up phone calls to include
Purpose of follow-up phone calls
Calls should take 5-10 minutes
Complete follow-up calls 2-5 days after, patient is discharged
Fill out the evaluation table during every call
Turn the evaluation tool into Darcy at the end of each month
What is NOT a purpose of follow-up
phone calls post-discharge?
a. Improve medication and aftercare adherence
b. Prevent hospitalization
c. Make sure patients are attending meetings
d. Improve patient outcome
e. Additional step to show we care about the patient’s
outcome after they leave the hospital
What major area is NOT
included in the script?
a. Sobriety
b. Social-support
c. Depression and anxiety scale
d. Outpatient appointments
e. Medication
References
Cook, P. F., Emiliozzi, S., Waters, C., & El Hajj, D. (2008). Effects of telephone counseling on
antipsychotic adherence and emergency department utilization. The American Journal of
Managed Care, 14(12), 841-846.
D'Amore, J., Murray, J., Powers, H., & Johnson, C. (2011). Does telephone follow-up predict
patient satisfaction and readmission? Population Health Managment, 14(5), 249-255.
doi:10.1089/pop.2010.0045
Dutkiewicz, C. (2010, February). Follow-up calls help avoid readmissions. Healthcare
Benchmarks and Quality Improvement. pp. 21-23.
Harrison, P. L., Hara, P. A., Pope, J. E., Young, M. C., & Rula, E. Y. (2011). The impact of
postdischarge telephonic follow-up on hospital readmissions. Population Health
Managment, 14(1), 27-32. doi:10.1089/pop.2009.0076
Healthcare Cost and Utilization Project (2011). All patient readmissions within 30 days:
National Statistics, 2011. Retrieved from American Healthcare Research and Quality
website: www.hcupnet.ahrq.gov
Luxton, D. D., June, J. D., & Comtois, K. A. (2013). Can postdischarge follow-up contacts
prevent suicide and suicidal behavior? The Journal of Crisis Intervention and Suicide
Prevention, 34(1), 32-41. doi:10.1027/0227-5910/a000158
Melton, D. L., Foreman, C., Scott, E., McGinnis, M., & Cousins, M. (2012). Prioritized post-
discharge telephonic outreach reduces hospital readmissions for select high-risk patients.
The American Journal of Managed Care, 18(12), 838-844.
Steffen, S., Kosters, M., Becker, T., & Puschner, B. (2009). Dishcarge planning in mental health
care: a systematic review of the recent literature. Acta Psychiatrica Scandinavica, 120, 1-
9. doi:10.111/j.1600-0447.2009.01373.x