Face-to-Face Meetings: Effect on Telephone Follow-Up Reach Rates, Emergency Department Visits, and Hospital Readmissions

Friday, 26 July 2019: 11:20 AM

Franz Henryk Vergara, PhD, DNP, RN, ONC, CCM1
Jean Davis, PhD, RN, FAAN2
Daniel Sheridan, PhD, RN, FAAN3
Nancy Sullivan, DNP, RN4
Chakra Budhathoki, PhD4
(1)The Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
(2)The Goldfarb School of Nursing at Barnes Jewish College, St. Louis, MO, USA
(3)College of Nursing, Texas A&M University, Bryan, TX, USA
(4)School of Nursing, The Johns Hopkins University, Baltimore, MD, USA

Purpose:

1. To determine the impact of a pre-hospital discharge face-to-face meeting on the post-hospital discharge telephone follow-up reach rates of surgical patients; and

2. To determine the association of successfully reaching patients post-hospital discharge on subsequent emergency department visits and hospital readmission rates of surgical patients.

Methods:

A quasi-experimental research using a posttest-only design with a comparison group was used; a convenience sampling technique was employed. Participants were recruited from two surgical units servicing neurosurgery and adult orthopaedic spine. Eligible patients in the study were those who were 18 years of age, qualified for a PAL call, and had a surgical procedure during admission.

Power analysis a priori was conducted and required a total of 176 participants to obtain 80% power; 88 patients were allocated on each group. Face-to-face meetings pre-hospital discharge were conducted to 88 participants on the intervention unit. Patients (n = 88) on the comparison unit, received the traditional care of conducting a telephone follow-up, but without a face-to-face meeting pre-hospital discharge. Pearson’s chi-square test was employed to determine any association or any significant difference between the intervention and comparison groups’ telephone follow-up reach rates, subsequent emergency department visits, and hospital readmissions.

Results:

Cross tabulation and Pearson’s chi-square were conducted and the intervention group demonstrated higher TFU reach rates (n = 86; 97.7%) in contrast with the comparison group (n = 67; 76.1%) and also showed statistical significance (p < 0.001). These telephone follow-up reach rates have been demonstrated (67% and 99%) previously on several studies which utilized face-to-face meetings of transitional nurses on medicine patients before hospital discharge (Menchine et al., 2013; Coleman et al., 2006; Kind et al., 2012; Parry et al., 2009). It is possible that establishing rapport between the patient and the telephonic case manager prior to the telephone follow-up is beneficial for several reasons:

  1. The patient knows who will follow-up and have prior knowledge of the purpose of the phone call rather than just receiving a “cold call”.
  2. Forming a prior connection with the patient may have established trust to discuss confidential health information.
  3. Establishing the best time and accurate phone number to call ensure the patient is “reachable” at the time of the post discharge TFU.

Cross-tabulation and Pearson’s chi-square of subsequent ED visits of reached and not-reached participants from both groups were performed. The percentage of patients who were reached had lower rates of ED visits (7.8%) compared to those who were not reached (17.4%), but the difference was not statistically significant (p < .294) because the total number of patients who visited the emergency department was very small (n = 16), making it difficult to make an inference. Nonetheless, this information is clinically significant that needed further investigation with a larger sample in future studies.

Additionally, a cross tabulation and Pearson’s chi-square of subsequent hospital readmissions were also performed. The readmission rate of surgical patients who were reached post-hospital discharge was lower (3.3 %) compared to the total readmission rates of not-reached patients (8.7%). This finding is also not statistically significant (p < .700) because of the very small number of patients who were readmitted (n = 7), therefore making an inference difficult. Nevertheless, these findings are considered clinically significant and that future study regarding surgical patients is needed. Although, the readmission rates from both the intervention and comparison groups are lower compared to the national readmission rates, something to consider is that post-operative surgical patients might be more prepared to post-hospital discharge care plans compared to other clinical specialties.

Face-to-face meetings may be used to reach out to more surgical patients after hospital discharge, thereby improving the quality of care and reducing readmissions. Although successfully reaching surgical patients after hospital discharge is not statistically significant with the number of emergency department visits and hospital readmission rates, this study found the clinical significance in conducting telephone follow-up to patients subsequent emergency department visits and hospital readmissions.

Conclusion:

  • Face-to-face meetings may be added to the standard of care because it increased TFU reach rates and assisted more patients in their post-hospital discharge care plans.
  • The PAL service was able to reduce readmissions and reduce ED visits that showed clinical significance.
  • Most surgical patients on the study had scheduled elective surgeries. The results of this research may not reflect for patients receiving emergency surgeries such as orthopaedic trauma. This warrant further study by using a larger sample in future research.
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