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