2 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.
3 Post Visit Calls BLG Post Visit Calls Traditional Focused on improving patient satisfaction onlyInconsistent ProcessServes as a stop gap for service failureLittle follow-up action with learningsFocused on quality and service of the patient experienceFollows a detailed protocol and processConfirms compliance and demonstration of understanding of the discharge instructionsHas accountability for follow upEnsures a safe transition to home
5 Discharge Phone CallsThe intent of Discharge Phone Calls is not to increase the patient’s perception of care.Discharge phone calls primary purpose is to impact clinical outcomes.Finally discharge phone callsharvest staff recognition,audit the patient’s perception of careimprove processes based on patient feedback.
7 Annals of Internal Medicine February 2003 “Nearly 1 in 5 patients”*Type of Adverse Events400 patients surveyedOther76 (19%) had adverse events after dischargeFall8%Nosocomial Infection4%5%Adverse Drug EventProcedure Related66%17%* 81 events occurred in 76 patients* “Adverse Events After Discharge from Hospital”, Annals of Internal Medicine, February 2003
9 Ineffective Communication This is a tremendousRisk factor for readmissionsOnly 42% of patients knew diagnosisOnly 28% knew medication namesOnly 37% knew purpose of medicationOnly 14% knew side effectsDischarge Calls can bridge the gaps.State University of New York Study Mayo Clinic Proceedings, August 2005
10 Tactics to support patient centered care: Words that workService behaviors such as responsiveness to call lightsHourly roundingLeader rounding on patientsDischarge Phone CallsStaff feedbackProcess Improvements
11 Post-Visit Calls- Big results for 5 minutes! Confirms compliance and understanding of discharge instructionsReduces complaints and claims, affords opportunity for service recoveryAllows for harvesting of positives for reward and recognitionIdentifies process improvement opportunitiesConfirms that hospital CARES about patient
12 Implementation Strategy: Methodology & Consistent ProtocolUsing the defined script, harvest informationTake Action:Address Clinical needs; Reward & coach
13 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 processEach LHP facility will initiate their Inpatient Discharge Phone Call process based on readiness decided by their coach and Senior Leaders.
14 Phased implementation process Phase 1: Emergency Department call backs Implement based on a specific populationClarify the script to be used including documentation of “notification/schedule of call on DC instructions”Establish who will make the callsCapture the data in the BLG/Eclipse Discharge Call Software
15 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 Patient’s discharged to home to be called back within hours post discharge:Abdominal PainChest PainHead InjuryFever of Undetermined OriginChildren under the age of 1Elderly that had fallenLeft without seen and AMAPatient’s with severe neurological changes
16 Guidelines for Implementing the Discharge Phone Call Process Set the Goal :Decide the expected outcome from making the Discharge Callsie 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.
18 Guidelines for Process cont When: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?”
21 How do we do discharge phone calls? Review the phone script that includes:Empathy and concern and uses WTWClinical OutcomesReward & RecognitionUnderstanding patient’s perception of careGather process improvement suggestions
22 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?____
24 Track findings to include the following: Patient NameDischarge DateDate and Time of 1st CallVoice Mail/Left MessageDate and Time of 2nd CallDate and Time of 3rd CallEmpathy and ConcernClinical OutcomesMedicationsHome CareFollow-up AppointmentReward and RecognitionProcess Opportunities
25 Next Steps: Finalize process for your Hospital Discuss plan for implementation with your unit based council or staffDevelop 90 day plan to implement discharge phone callsRole model making the discharge phone calls to pilot the processImplement discharge phone callsCommunicate back to staff wins and opportunities for improvement from the discharge phone callsTrack success rate and evaluate effectiveness of calls.