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Description

Practice Problem
No clearly defined process exists for clarification of discharge instructions or other parental concerns after discharge. Follow-up appointments with the primary care provider or a subspecialist are listed on discharge instructions with the main hospital number to call after discharge. Hospital operators send calls to inpatient units where the patient was most recently discharged. This causes disruptions for nursing floor staff and unnecessary emergency room visits. No literature was identified for calls to a centralized call center after discharge. Literature shows the most frequent reason for calling after discharge were common concerns such as fever, ENT, respiratory and digestive symptoms.

PICO Question
In pediatric patients discharged from an inpatient hospitalization within 72 hours, does having a centralized call hub for questions and concerns after discharge help identify barriers for successful self-management at home?

Implementation/Pilot
Only Plano Hospitalist Medicine group patients discharged within 72 hours were studied. Calls were tracked and identified by a specific group number in triage calls. Nurses created both a telephone and triage note. If no triage protocol was needed, only a telephone note was documented.

Practice Changes
Proposed changes Included providing patients a direct phone number for 24/7 access to experienced triage nurses on discharge paperwork. A post-discharge text program called Patient EXP was added to contact the triage nurse if the parent needs to speak to a nurse.

Outcomes
Most calls (43%) concerned worsening symptoms, 17% were clarification of management, and 16% for both. Most calls were for newly diagnosed diabetics, followed by gastrointestinal disorders. Triage recommendations were 2% for 911 access, 26% refer to ER, and 40 % for home care. One patient was admitted for surgery. Two patients were admitted to PICU, and 24 parents continued to call 72 hours after discharge. Calls with ED or 911 a recommendation had 13% of patients readmitted. The Centralized Call Hub identified post-discharge concerns and assisted staff and patients with care after discharge.

Publication Date

2021

Disciplines

Pediatric Nursing

After Discharge Call Management Utilizing a Centralized Call Hub

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