Hospital discharge represents a “voltage drop” in care that can lead to unexpected problems including costly readmission. Postdischarge phone calling is a strategy advocated by national and local organizations to improve the quality of care transitions. A recent review concluded that postdischarge phone calling is a component of successful discharge bundles. Our hospital’s Safe Transitions initiative directs physicians to contact high risk patients within 72 hours of discharge, but we found that hospitalists struggled to perform this task due to time constraints and a frustratingly low contact rate. A better strategy was needed.
Our goal was to develop an efficient and effective means of contacting discharged patients by phone without distracting hospitalists from acute clinical duties and at the same time preserving the benefit of their involvement. Secondary goals were to assess the frequency of unexpected clinical developments, patient interest in speaking with hospitalists, and impact on 30day readmissions.
Undergraduate students were trained to call discharged patients using a limited script containing (1) a query about unexpected clinical events and (2) an offer to speak with the hospitalist. Patients transitioned to nursing homes, adult care facilities, and jails, deceased patients, and those readmitted before telephone contact could be made were excluded (95 patients over a 3 3month study period). Up to 2 two attempts were made to reach each patient within 3 days of discharge. Students attempted to contact 742 patients and successfully contacted 422 (57% contact rate). 31 Thirtyone patients reported experiencing unexpected problems after discharge (7%) and 22 asked to speak with a hospitalist (5%). 56 of 422 contacted patients were readmitted within 30 days of discharge (13.3%), while 47 of 320 patients not contacted were readmitted (14.7%). Five of 31 patients reporting unexpected problems were readmitted (16%); 4 of 22 asking to speak with the hospitalist were readmitted (18%). The direct cost of the program was $1,966/3 months ($655/mo), or $2.65/patient. Students earned $10/hr.
This pilot study demonstrates that college students can screen a diverse pool of patients discharged by hospitalists for problems after discharge. The relatively low contact rate, low rate of unexpected problems, and even lower rate of asking to speak to hospitalists lead us to conclude that this is a costeffective effort. It is unclear whether this program is impacting readmission rates. Future analysis will assess demographic and clinical variables of the various groups of patients identified in the study. We will also assess hospitalist satisfaction and estimate the cost savings of employing college students to make screening calls. Lastly, we plan to modify our phone script and calling protocol in hopes of making a true impact on 30day readmissions.
To cite this abstract:Rudmann A, Dallasen R. Impact of Employing College Students to Make Limited Postdischarge Phone Calls for Hospitalists. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97698. Journal of Hospital Medicine. 2012; 7 (suppl 2). https://www.shmabstracts.com/abstract/impact-of-employing-college-students-to-make-limited-postdischarge-phone-calls-for-hospitalists/. Accessed September 17, 2019.