THE DISCHARGE HOTLINE INITIATIVE: IMPROVING TRANSITIONS OF CARE

Dr. Tao Xu, MD*;Andrew Dunn, MD, MPH and Mather Jogendra, MD, MSc, Icahn School of Medicine at Mount Sinai, New York, NY

Meeting: Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev.

Abstract number: 273

Categories: Innovations Abstracts, Transitions of Care

Background: Patient safety can be jeopardized if there is inadequate transitional care planning as patients move from the hospital to the outpatient setting. A reliable means for patients and their caregivers to reach a physician is crucial during this vulnerable period to ensure continuity of care. However, patients may be unsure who to contact after discharge when they have questions about residual or new symptoms, or of any changes in medications prescribed at the time of discharge. Patients may not be able to reach their primary care physician (PCP) during this period, or have no established PCP and therefore have no one to contact. Without clear guidance, patients may deteriorate, suffer complications, or return to the emergency department unnecessarily. We have developed a pilot program to facilitate post-discharge phone calls that would increase the number of calls, provide a safety net for patients during transitions of care, and improve physician-patient communication. 

Purpose: To evaluate the effectiveness of a discharge hotline led by hospitalists in increasing patient calls to improve communication with hospitalists after discharge. 

Description: The program entailed modifying the discharge process of the Division of Hospital Medicine at Mount Sinai Hospital. The existing answering service number was utilized as a “Discharge Hotline”. This intervention was implemented for all patients admitted to the hospitalist group, which included the teaching service and a non-teaching service. During the 24 to 48 hours prior to discharge, the patient’s hospitalist provided the patient with a simple and colorful Discharge Hotline Card with the telephone number, hospitalist’s name, and the instruction for the patient to call for issues related to their hospitalization. During business hours, calls were received by an administrative assistant and routed to the discharging physician for resolution. Calls received after-hours and during the weekends were received by an answering service and routed to a nocturnist at night and to one of the hospitalists on-call for the weekend during weekend daytime hours. The calls logs were collected monthly from the answering service and divisional administrative assistants. The group’s readmission rate was tracked to determine if the intervention had an impact on clinical outcomes. 

Conclusions: The pre-intervention group included 367 discharged patients, of which 5.7% of the patients called after discharge. Of the 5024 discharged patients during the post-intervention group spanning eighteen months, 12.53% called after discharge (P<0.0002). We surveyed the hospitalist group for physician perception of the discharge hotline. 25 out of the 28 physicians surveyed responded, with 80% indicating that the intervention facilitated the discharge of patients. The discharge hotline intervention is a cost-effective and simple tool, applying a minor modification to an existing call center system and the physician discharge process. The hotline also serves as a safety-net for patients in the vulnerable post-discharge period. There was evidence that it resulted in an increase in the number of patients contacting physicians after discharge for discharge related concerns. Ongoing data collection of the discharge related patient calls is necessary to demonstrate a consistent longitudinal positive impact of the intervention, including long-term impact on readmission rate and patient satisfaction.

To cite this abstract:

Xu, T; Dunn, A; Jogendra, M . THE DISCHARGE HOTLINE INITIATIVE: IMPROVING TRANSITIONS OF CARE. Abstract published at Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev. Abstract 273. Journal of Hospital Medicine. 2017; 12 (suppl 2). https://www.shmabstracts.com/abstract/the-discharge-hotline-initiative-improving-transitions-of-care/. Accessed September 23, 2019.

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