Postdischarge Problems Identified by Nurse Advice Line Calls Following Hospital Discharge

Meeting: Hospital Medicine 2012, April 1-4, San Diego, Calif.

Abstract number: 97560

Background:

Approximately 20% of patients are either readmitted or have additional visits to emergency rooms or urgent care clinics within 30 days of hospital discharge. Patients discharged from our urban, academic safety net hospital are given the phone number for a Nurse Advice Line and are instructed to call, if they have questions or experience problems following discharge. The objective of this study is to examine the calls received by this advice line to see, if they might suggest modifications in our discharge process.

Methods:

All calls from discharged patients received over a 2–month period were examined with the exception of those from patients <18 years of age, those known to be pregnant and those without a medical record number in our database. We recorded the demographics of the callers, timing of the call relative to discharge and whether the problem was followed by a readmission or a visit to the emergency department or urgent care clinic. The problems identified were classified using the following taxonomy: deterioration in medical condition, postoperative problem, knowledge deficit, or unknown.

Results:

From September 14 to November 8, 2011, 93 patients met inclusion criteria (Table), 2% of all patients discharged during this same period. Over 80% of calls were from patients who had surgical procedures. The most common reasons for calling were postoperative problems (55%, such as uncontrolled pain or wound problems) and knowledge deficits (14%, especially related to wound care instructions). The median time from discharge to call was 3 days (95% CI 2–5) but ∼15% of patients called on the same day they were discharged. Forty–three percent of patients had either an emergency room or urgent care encounter or were readmitted to the hospital within 30 days.

Conclusions:

Although only a small minority of patients discharged from our hospital utilized the Nurse Advice Line, the problems identified, together with the high readmission rate in this subgroup, suggest several areas in which our predischarge processes can be improved.

Table 1Patient Calls to Nurse Line (N= 93)

Age (mean [pm] SD) 41 [pm] 14
Gender: male, N (%) 46 (49)
Race/ethnicity, N (%)
  Hispanic/Latino/Spanish 40 (43)
  African–American 15 (16)
  White 34 (37)
Language, N (%)
  English 84 (90)
  Spanish 8 (9)
Payer, N (%)
  Medicare 12 (13)
  Medicaid 28 (30)
  Commercial 14 (15)
  Medically indigent 30 (32)
Discharge service, N (%)
  Surgery 75 (81)
  Inpatient surgery 42 (45)
  Ambulatory surgery 33 (35)
  Medicine 13 (14)
  Other 5 (5)
Days between discharge and call, median (95% CI) 3 (2–5)
Type of problem, N (%)*
  Deterioration of existing medical condition 16 (16)
  Postoperative problem 56 (55)
  Knowledge deficit 14 (14)
  System issue 5 (5)
  Unknown 10 (10)
Readmission within 30 days (inpatient, emergent, or urgent visit), N (%) 40 (43)
Calls may be in more than one category.

To cite this abstract:

Keniston A, Savoie C, Mancini D, Bogdan G, Zoucha J, Burden M, Allyn R, Albert R, Stella S. Postdischarge Problems Identified by Nurse Advice Line Calls Following Hospital Discharge. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97560. Journal of Hospital Medicine. 2012; 7 (suppl 2). https://www.shmabstracts.com/abstract/postdischarge-problems-identified-by-nurse-advice-line-calls-following-hospital-discharge/. Accessed May 22, 2019.

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