Do post-discharge telephone calls to patients reduce the rate of complications?

Post-discharge follow-up telephone calls also can benefit patients discharged from the hospital. A recent paper reported that approximately 12% of patients develop new or worsening symptoms within a few days post-discharge and adverse drug events can occur in between 23% to 49% of people during this transition period.8-10

Another study evaluating resource use in heart failure patients found follow-up telephone calls significantly decreased the average number of hospital days over six months time and readmission rate at six months in the call group, as well as increased patient satisfaction.11

A randomized placebo-controlled trial evaluating follow-up calls from pharmacists to discharged medical patients found the call group patients were more satisfied with their post-discharge care. Additionally, there were less ED visits within 30 days of discharge in the call group compared to placebo or standard care.12

On the other hand, several studies have questioned the utility of follow-up telephone calls for improving transitions of care. A Stanford University group divided medical and surgical patients into three groups with one receiving routine follow-up calls, another requiring a patient-initiated call and a final group without any intervention and found there was no difference between these groups in regards to patient satisfaction or 30-day readmission rates.13

An outpatient trial completed at a South Dakota Veterans Affairs clinic also determined telephone calls had little effect on decreasing resources or hospital admissions.14

Although this study did not include inpatients, it demonstrates the fact that follow-up telephone calls may not be as helpful as shown in other trials and that more thorough and well-designed trials are needed to more definitively answer this question.

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The hospitalist makes a call to the patient to follow-up after he is discharged, and he says he is glad she called. He had questions about one of his medications that was discontinued while he was hospitalized and wants to know if he should restart it. He also says he is having low-grade fevers again and is not sure if he should come back in for evaluation.

The hospitalist is able to answer his questions about his medication list and instructs him to restart the metformin they had stopped while he was an inpatient. The hospitalist also is able to better explain what symptoms to be aware of and when the patient should come in for re-evaluation. The patient appreciates the five-minute call, and the hospitalist is glad she cleared up the patient’s confusion regarding his medications before a serious error or unnecessary readmission to the hospital occurred. TH

Dr. Moulds is a third-year internal medicine resident at the University of Colorado Denver. Dr. Epstein is director of medical affairs and clinical research at IPC-The Hospitalist Company.

References

1. www.cdc.gov.
2. Epstein K, Juarez E, Loya K, Gorman MJ, Singer A. Frequency of new or worsening symptoms in the post-hospitalization period. J Hosp Med. 2007 Mar;2(2):58-68.
3. Mistiaen P, Poot E. Telephone follow-up, initiated by a hospital-based health professional, for post-discharge problems in patients discharged from hospital to home. Cochrane Database Syst Rev. 2006, Issue 4. Art. No.: CD004510. DOI:10.1002/14651858.CD004510.pub3.
4. Shesser R, Smith M, Adams S, Walls R, Paxton M. The effectiveness of an organized follow-up system. Ann Emerg Med. 1986 Aug;15(8):911-915.
5. Jones J, Clark W, Bradford J, Dougherty J. Efficacy of a telephone follow-up system in the emergency department. J Emerg Med. 1988 May-June;6(3):249-254.
6. Jones JS, Young MS, LaFleur RA, Brown MD. Effectiveness of an organized follow-up system for elder patients released from the emergency department. Acad Emerg Med. 1997 Dec;4(12):1147-1152.
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9. Forster A, Murff H, Peterson J, Gandhi T, Bates D. Adverse drug events occurring following hospital discharge. J Gen Intern Med. 2005;20:317-323.
10. Forster A, Murff H, Peterson J, Gandhi T, Bates D. The incidence and severity of adverse events affecting patients after discharge from the hospital. Ann Intern Med. 2003;138:161-167.
11. Riegel B, Carlson B, Kopp Z, LePetri B, Glaser D, Unger A. Effect of a standardized nurse case-management telephone intervention on resource use in patients with chronic heart failure. Arch Intern Med. 2002 Mar 25;162(6):705-712.
12. Dudas V, Bookwalter T, Kerr KM, Pantilat SZ. The impact of follow-up telephone calls to patients after hospitalization. Am J Med. 2001 Dec 21;111(9B):26S-30S.
13. Bostrom J, Caldwell J, McGuire K, Everson D. Telephone follow-up after discharge from the hospital: does it make a difference? Appl Nurs Res. 1996 May;9(2):47-52.
14. Welch HG, Johnson DJ, Edson R. Telephone care as an adjunct to routine medical follow-up. A negative randomized trial. Eff Clin Pract. 2000 May-June;3(3):123-130.
15. Coleman E, Smith J, Raha D, Min S. Posthospital medication discrepancies. Arch Intern Med. 2005;165:1842-1847.