Ndsu school of Nursing Bismarck Clinical Question



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Post-discharge Follow-up Calls

Appraised by: Amber Kindt SN, Heather Martin SN, Jenna Schaff SN, and

McKensy Friedt SN



NDSU School of Nursing Bismarck

Clinical Question:

In patients hospitalized with chronic conditions, does an automatic follow-up phone calls after hospital discharge decrease hospital readmission within 30 days?



Articles:

Harrison, J. D., Auerbach, A. D., Quinn, K., Kynoch, E., Mourad, M. (2014). Assessing the impact of nurse post-discharge telephone calls on 30-day hospital readmission rates. Journal of General Internal Medicine. 29(11). 1519-1525. doi: 10.1007/s11606-014- 2954-2


Harrison, L. P., Hara, A. P., Pope, E. J., Young C. M., Rula, Y. E. (2011). The impact of post-discharge telephonic follow-up on hospital readmissions. Population Health Management. 14. 27-31. doi: 10.1089/pop.2009.0076
Inouge, S., Vasileios, B., Shouldis, E., Johnstone, A., Silverweig, Z., Kosuri, P. (2015). Predicting readmission of heart failure patients using automated follow-up calls. BMC Medical Informatics & Decision Making, 15(22), 1-6. doi:10.1186/s12911-015-0144-8
Riegel, B., Beverly, C., Kopp, Z., Lepetri, B., Galser, D., Unger, A. (2002). Effect of a standardized nurse case-management telephone intervention on resource use in patients with chronic heart failure. American Medical Association,162(6), 705-712.
Synthesis of Evidence:

This report includes 4 different studies: retrospective observational study, retrospective cohort study, quasi-experimental study, and a random control trial.

Harrison, Auerbach, Quinn, Kynoch, and Mourad (2014) conducted a retrospective observational study. This study was conducted to determine the specific effects of receiving a post-discharge telephone call on 30-day readmission rates, and to describe the post-discharge issues addressed by the calls. The study was performed in the Medicine Service at the UCSFMC. The study included patients admitted between November 2010 and May 2012, and included 5507 patients after exclusion criteria. The intervention studied was if a post-discharge phone call would decrease readmission rates. Nurses appointed to the task called the patients at least twice during the 72-hour period post-discharge. The patients were divided into two groups: those who received a call and those who didn’t. It was found that those who completed the call survey had a 5.8% chance of being readmitted. The non-white population consistently demonstrated a decrease in 30-day readmission rates associated with receiving call intervention. Those who didn’t receive the calls had an 8.3% chance of being readmitted. The study concluded that the post-op discharge calls within 72 hours of discharge do decrease the risk of readmissions.

Harrison, Hara, Pope, Young, Rula, (2011) conducted a retrospective cohort study with the primary focus of determining if follow up calls post-discharge affect the re-admission rates among chronically ill patients including; asthma, coronary artery disease, chronic kidney disease, chronic obstructive pulmonary disease, depression, diabetes, end-stage renal disease, and heart failure would decrease or remain the same 30 days post-discharge. There were two groups the control group and the comparison group, the criteria to be included in the study was the participant needed to have one of the chronic illnesses out of thirteen listed on the guidelines for participation in the study. During the calendar year of 2008, 30372 patients were involved in the study. This study showed patients who were called early to reduce the readmission rates. Nearly 1/3 of the re-admissions occurred within the first week after discharge, and the participants that were called 14 days post discharge were more at risk for readmission within 30days post discharge. This study showed for the best outcome, the participants should be called 1-4 days post discharge.

Inouye, Bouras, Shouldis, Johnston, Silverzweig and Kosuri (2015) conducted a quasi-experimental study, which assessed the effectiveness of automated phone calls to patients after discharge to reduce readmission rates. The study consisted of 1095 patients who were discharged from Charleston, West Virginia Charleston Area Medical Center, between December 2010 and September 2012. Patients had to be 18 years of age, English speaking, had a valid phone number, and had been admitted with a diagnosis of heart failure to participate in the study. All participants received two automated phone calls. The first phone call was made within 48 hours after discharge and questions consisted of general health status, medications, follow-up appointments, and weight gain. The second call was made 7 days later, which consisted of similar questions as the first phone call with a fifth question about the maintenance of a low-sodium diet. Inouge, S., et. al. (2015) found that using this simple method through automated phone calls, identified patients with HF who are at high risk for readmission. The follow-up calls helped to evaluate high risk patients and stratify them according to their responses of the follow-up calls for readmission. Findings included 837pts. (76%) responded to the general status question in at least one call, and 515 pts. (47%) responded to general status question in both calls, 244 pt. were readmitted within 30 days of discharge, and of the 515 patients who completed both follow-up calls, 89 exhibited a negative response, 329 exhibited a neutral trend and 97 exhibited a positive trend, among the pts. with positive or neutral trends readmission rates were 16% and 14% and pts. with a negative trend readmission rate was 37%, Response to general status question P= of 0.0323, Response trend less than P=0.0001, first call 0.0324, and second call P=less than 0.0001 This study, also helped to determine certain interventions to lower the readmission rates for patients and to improve better patient outcomes.

Riegel, Carlson, Zoe Kopp, LePetri, Glaser, and Unger (2002) conducted a randomized controlled trial to assess the effectiveness of a standardized telephonic case-management intervention in decreasing resource use in patients with chronic heart failure. In this randomized controlled clinical trial, patients were identified at hospitalization and assigned to receive 6 months of intervention (n=130) or usual care (n=228) based on the group to which their physician was randomized. Intervention group was telephoned within 5 days after hospital discharge and thereafter at a frequency guided by the software and case manager judgement based on patient symptoms, knowledge, and needs. Care for patients in the usual care control group was not standardized, and no formal telephonic case management program was in existence at these institutions. This study concluded that the heart failure hospitalization rate was 45.7% lower in the intervention group at 3 months (P=.03) and 47.8% lower at 6 months (P=.01)



Conclusion:

All four articles indicated follow-up calls post-discharge decrease readmission rates. Research shows making follow-up calls after discharge help to follow-up with patients' health, knowledge of medications, and instructions of self-care. Follow-up calls can also help identify patients who are at risk of being readmitted to the hospital. In addition, follow-up calls can help nurses know if certain key points, or questions need to be made clearer, or if changes need to be made to help the patient understand, and reduce readmission rates. Patients with chronic illnesses need more educational opportunities, thus why follow-up calls are a very important part of the patient's plan of care. Evidence shows the optimal time for success in reducing readmission rates is 1-4 days post discharge.



Implications for Nursing Practice:

These clinical findings suggest that follow-up phone calls after discharge are significant because they can help medical staff to implement better interventions, create new strategies to reduce patient readmissions to the hospital, and gather other relevant information needed to reduce readmissions.

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