Post Visit/Discharge Calls A best practice to assure continuity of care and a thorough understanding of how to transition safely to home and self care.
Post Visit Calls Traditional Focused on improving patient satisfaction only Inconsistent Process Serves as a stop gap for service failure Little follow-up action with learnings BLG Post Visit Calls Focused on quality and service of the patient experience Follows a detailed protocol and process Confirms compliance and demonstration of understanding of the discharge instructions Has accountability for follow up Ensures a safe transition to home
Discharge Phone Calls The intent of Discharge Phone Calls is not to increase the patients perception of care. Discharge phone calls primary purpose is to impact clinical outcomes. Finally discharge phone calls – harvest staff recognition, –audit the patients perception of care – improve processes based on patient feedback.
Annals of Internal Medicine February 2003 Type of Adverse Events 66% 17% 5% 8% 4% Adverse Drug Event Procedure Related Nosocomial Infection Fall Other * 81 events occurred in 76 patients Nearly 1 in 5 patients* 400 patients surveyed 76 (19%) had adverse events after discharge * Adverse Events After Discharge from Hospital, Annals of Internal Medicine, February 2003
Ineffective Communication Only 42% of patients knew diagnosis Only 28% knew medication names Only 37% knew purpose of medication Only 14% knew side effects Discharge Calls can bridge the gaps. State University of New York Study Mayo Clinic Proceedings, August 2005
Tactics to support patient centered care: Words that work Service behaviors such as responsiveness to call lights Hourly rounding Leader rounding on patients Discharge Phone Calls Staff feedback Process Improvements
Post-Visit Calls- Big results for 5 minutes! Confirms compliance and understanding of discharge instructions Reduces complaints and claims, affords opportunity for service recovery Allows for harvesting of positives for reward and recognition Identifies process improvement opportunities Confirms that hospital CARES about patient
Implementation Strategy: Methodology & Consistent Protocol Using the defined script, harvest information Take Action: Address Clinical needs; Reward & coach
Timeline for Implementation of Discharge Phone Calls Each LHP facility to identify a site administrator for ED and Inpatients calls who will receive additional training on the D/C call software. This is the first line troubleshooter per facility. March 1, 2013 Implement ED D/C Phone call process Each LHP facility will initiate their Inpatient Discharge Phone Call process based on readiness decided by their coach and Senior Leaders.
Phased implementation process Phase 1: Emergency Department call backs Implement based on a specific population Clarify the script to be used including documentation of notification/schedule of call on DC instructions Establish who will make the calls Capture the data in the BLG/Eclipse Discharge Call Software
Discharge Phone Calls for the Emergency Department The purpose of Discharge phone calls in the Emergency Department is to assure the patient follows through with their instructions to assure an optimum outcome and to evaluate whether there is any further progression of their condition that may placed them in jeopardy if left untreated. For this reason Baptist Leadership Group recommends the following group of high risk patients be identified for a post visit call at the time of discharge. This list can be adjusted based on the input from the Medical Director of the Emergency Department. High Risk Patients discharged to home to be called back within hours post discharge: Abdominal Pain Chest Pain Head Injury Fever of Undetermined Origin Children under the age of 1 Elderly that had fallen Left without seen and AMA Patients with severe neurological changes
Guidelines for Implementing the Discharge Phone Call Process Set the Goal : 1.Decide the expected outcome from making the Discharge Calls ie Decrease # of readmissions for COPD; decrease # ED readmits; improve patient satisfaction etc. 2. Decide how many patients you will call and how many attempts you will make to reach the patient. An example of this is to call 100% of all COPD patients up to three attempts within the first 72 hours of discharge.
Guidelines for Process cont When: 1.Decide what the initial timeframe for post-discharge calls should be to make the call. ( Best Practice <24h) 2. Decide how many attempts will be made to contact the patient. Decide what message should be left on voice mail. 3. Decide how to set the expectation for the patient at discharge that they can expect a discharge phone call ( consider documenting and validating on DC instruction sheet) 4. Create plan to inform patient of plan to call at time of discharge using words that work. Part of excellent care here at ____- is making sure our patients understand all their instructions so I will be calling you tomorrow afternoon, is this the correct phone number to reach you at ?
How do we do discharge phone calls? Review the phone script that includes: 1.Empathy and concern and uses WTW 2.Clinical Outcomes 3.Reward & Recognition 4.Understanding patients perception of care 5.Gather process improvement suggestions
Emergency Phone Script: Discharge Phone Call Script for Emergency Rooms: Hello I am ____________, a Nurse from________________ calling you back following your visit to our emergency department on ________________. I want to make sure you are doing ok and answer any questions you may have regarding the instructions that were given to you to care for yourself at home. Have you improved since the visit? ___________________________________ Have you gotten any prescriptions filled that were ordered at the time of discharge?__________________________________________________ Do you have any questions regarding the medications you are taking?_____________________________________________________ Were you able to make arrangements for a follow up appointment if one was recommended?_______________________________________________ Can you share with me how your experience was at the Emergency Department with the Physician and Nursing staff?____________________________________ We like to recognize our employees for providing very good care. Was there anyone you would like us to recognize?____
Track findings to include the following: 1.Patient Name 2.Discharge Date 3.Date and Time of 1 st Call 4.Voice Mail/Left Message 5.Date and Time of 2 nd Call 6.Date and Time of 3 rd Call 7.Empathy and Concern 8.Clinical Outcomes 9.Medications 10.Home Care 11.Follow-up Appointment 12.Reward and Recognition 13.Process Opportunities
Next Steps: Finalize process for your Hospital Discuss plan for implementation with your unit based council or staff Develop 90 day plan to implement discharge phone calls Role model making the discharge phone calls to pilot the process Implement discharge phone calls Communicate back to staff wins and opportunities for improvement from the discharge phone calls Track success rate and evaluate effectiveness of calls.