DO YOU CALL YOUR PATIENTS AFTER DISCHARGE?
Discharge telephone calls have been suggested as a method to increase patient satisfaction, therapy compliance, and follow-up while decreasing readmission rates and cost. Is there evidence to support this practice?
This retrospective observational analysis asked the question, “How does a postdischarge telephone call affect 30-day readmission in a general adult medicine population?” Patients were called within 72 hours after discharge by a nurse with the purpose of solving issues related to discharge (eg, medications, follow-up care).
The key findings.
Patients who were called and reached had a 5.8% readmission rate. Patients who were called but not reached or who did not complete the telephone call had a readmission rate of 8.6%. Other patients for whom there was no attempt to complete a call were readmitted at a rate of 8.3%. It would seem that a simple telephone call decreased readmission rates by ∼29% (adjusted odds ratio [aOR]: 0.71 [95% confidence interval (CI): 0.55–0.91]). However, when the data were adjusted to account for demographic characteristics that might have introduced bias in selection of patients included, no association between receiving a call and readmission rate was observed for the population as a whole (aOR: 0.91 [95% CI: 0.69–1.2]). Subgroup analysis found that non-white patients were 33% less likely to be readmitted when called and reached, even after adjusting (according to propensity score) for potential selection bias (aOR: 0.67 [95% CI: 0.48–0.94]). Therefore, although this study suggests that postdischarge calls are unlikely to prevent readmission for the population as a whole, non-white patients may benefit from calls.
Why do we care?
A discharge telephone call is an inexpensive intervention that has the potential to improve a number of quality measures (including patient satisfaction) and may even prevent readmission. Many emergency departments have become aware of this scenario and are making these calls. Project BOOST (Better Outcomes by Optimizing Safe Transitions), a Society of Hospital Medicine initiative aimed at optimizing and standardizing the hospital discharge process, includes provisions for follow-up calls. Perhaps calling our pediatric families will not only improve patient satisfaction and the increasingly monitored quality measure scores, but these calls may also alleviate the worry of a father of an infant with bronchiolitis. For me, this practice improves physician satisfaction as well.
Straight from the author…
“Our program has since expanded and all patients are called. We are determining if there is a specific population that benefits the most. We obtain a lot of useful feedback from the calls that helps improve our discharge safety and satisfaction. Also, the nurses derived a tremendous amount of satisfaction from making the calls...”
Citation: Harrison JD, Auerbach AD, Quinn K, Kynoch E, Mourad M. Assessing the impact of nurse post-discharge telephone calls on 30-day hospital readmission rates. J Gen Intern Med. 2014;29(11):1519–1525.
SHOULD WE OBTAIN BLOOD SPECIMENS FOR LABORATORY TESTS FROM EXISTING PERIPHERAL INTRAVENOUS (PIV) CATHETERS?
Blood tests are often important in the care of pediatric inpatients, but they may be the most frightening aspect of the stay for some children. Does evidence support drawing blood samples from existing PIVs to reduce the need for venipuncture?
This prospective observational study examined the rates of successful blood draws, unusable samples, and loss of PIVs after blood collection through an existing PIV. Pediatric patients were chosen from a convenience sample of inpatients with 18- to 24-gauge PIVs. Blood draws were conducted according to an institutional protocol developed for obtaining specimens in this manner.
The key findings.
A total of 150 specimens were collected from 80 children. The overall success rate for obtaining blood specimens from the preexisting PIV was 91.3%. There were no contaminated, hemolyzed, or insufficiently drawn samples. The odds of successfully obtaining the blood specimen were 2.3 higher as the catheter bore increased (gauge size lessened) by 1 unit (95% CI: 1.2–4.8). Two PIVs became nonfunctional after the blood specimen was obtained, which is a rate of 1.3%. No significant correlation was found between PIV failure and the gauge of the PIV (P = .58) or age of the PIV (P = 1.0). This study has a large source of bias from use of the convenience sample, meaning that the enrolled patients were selected from a nonrandomized sample without any planned distribution of demographic or disease factors. A more robust study would: (1) include larger numbers; (2) control for disease states and demographic factors; and (3) record patient and parent impressions of pain and fear compared with nonenrolled children.
Why do we care?
Straight from the author…
“Nurses who were less comfortable with sticking a child were more apt to attempt from the PIV. Some nurses were too afraid the PIV would stop working if used for a blood draw and therefore never drew from the PIV. We used our data to educate those who were skeptical to use the PIV to let them know that we did not see a problem with PIVs clotting from drawing blood from them.”
Citation: Braniff H, DeCarlo A, Haskamp AC, Broome ME. Pediatric blood sample collection from a pre-existing peripheral intravenous (PIV) catheter. J Pediatr Nurs. 2014;29(5):451–456.
FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.
FUNDING: No external funding.
POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.
- adjusted odds ratio
- condidence interval
- peripheral intravenous
- Accepted January 9, 2015.
- Copyright © 2015 by the American Academy of Pediatrics