Postdischarge problems identified by telephone calls to an advice line

• Published in: Journal of hospital medicine Vol. 9; no. 11; pp. 695 - 699
• Main Authors: Stella, Sarah A., Allyn, Rebecca, Keniston, Angela, Johnston, Laura B., Burden, Marisha, Bogdan, Gregory M., Savoie, Christine, Albert, Richard K.
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01.11.2014; Frontline Medical Communications
• Subjects: Adult; Aftercare - organization & administration; Aftercare - standards; Aftercare - statistics & numerical data; Colorado; Continuity of Patient Care - organization & administration; Continuity of Patient Care - standards; Continuity of Patient Care - statistics & numerical data; Female; Humans; Male; Nursing Diagnosis - methods; Nursing Diagnosis - statistics & numerical data; Patient Discharge - standards; Patient Discharge - statistics & numerical data; Patient Education as Topic - methods; Patient Education as Topic - statistics & numerical data; Patient Readmission - statistics & numerical data; Prospective Studies; Quality Improvement; Safety-net Providers - methods; Safety-net Providers - organization & administration; Safety-net Providers - statistics & numerical data; Telephone - standards; Telephone - statistics & numerical data; Triage - methods; Triage - statistics & numerical data; Colorado
• ISSN: 1553-5592; 1553-5606
• DOI: 10.1002/jhm.2252

BACKGROUND Problems experienced after hospital discharge can result in rehospitalizations and unscheduled urgent and emergent care. OBJECTIVE To identify opportunities for improving discharge processes by examining calls to an advice line (AL). DESIGN Prospective cohort. SETTING A 500‐bed, university‐affiliated hospital. PATIENTS Patients who called an AL between September 1, 2011 and September 1, 2012 and reported being hospitalized within 30 days. INTERVENTION None MEASUREMENTS Caller characteristics, timing of calls, nature of reported problems. RESULTS Over 1 year the AL received calls from 308 unique patients who were hospitalized or had outpatient surgery within 30 days preceding the call. Thirty‐one percent and 47% of calls occurred within 24 or 48 hours of discharge, respectively. Sixty‐three percent came from surgery patients despite surgery patients accounting for only 38% of the discharges. The most common issues were uncontrolled pain, questions about medications, and aftercare instructions (eg, the care of surgical wounds). The rates of 30‐day readmissions and urgent or emergent care visits were higher for patients who called the AL than for those who did not (15% vs 4% and 30% vs 7%, respectively, both P < 0.0001), but sample sizes were too small to accommodate robust matching or multivariate analysis. CONCLUSIONS Problems described in calls by patients to an AL identified several aspects of our discharge processes that needed improvement. Patients calling an AL following discharge may be at increased risk for 30‐day rehospitalization and urgent or emergent care visits. Journal of Hospital Medicine 2014;9:695–699. © 2014 Society of Hospital Medicine