Reviewer: Andrew Shriner, MD
Article: Heath J, Dancel R, and Stephens JR. “Postdischarge phone calls after pediatric hospitalization: An observational study.” Hosp Pediatr. 2015 May; 5 (5):241-8. doi: 10.1542/hpeds.2014-0069. (Link)
Why this article? Transition of care for children after a hospitalization has been a focus of a significant amount of research in an attempt to reduce issues such as misunderstanding of discharge instructions, difficulty filling prescriptions or giving medications appropriately or readmissions. While there’s ongoing debate about the preventability of pediatric readmissions, with recent healthcare changes, this focus is unlikely to shift in the near future and there are certainly other ways that patients and families may benefit from efforts to improve the transition of care process.
Methods: Over a 12-month period, the hospitalists in this study implemented a standardized attending physician phone call to the family of all discharged patients within 72 hours of discharge to check in on any problems with the transition of care. Charts were reviewed for any difficulties identified, readmissions (14 and 30-days), ED visits, patient satisfaction scores. Findings were compared to patient’s discharged over the preceding 12 months.
Results: There were 661 discharges over the study period and 606 discharges in the comparison group from the prior year. Seventy-eight percent of families (n = 513) were reached via phone call during the study period (up from 50% prior to their intervention). A problem was identified in nearly 20% of the families who were reached with about half of the issues being related to medication issues. About 1/3 of the problems identified were found to need a significant action to be taken by the physician (such as contacting another provider or calling in a new prescription).
There were no statistically significant reductions in ED visit rates, readmissions or patient satisfaction scores, but there was a trend towards improvement in all of these outcomes.
Conclusions/Discussion: This was an interesting study on looking at how to reduce the risk of poor outcomes after inpatient discharges for pediatric patients. There are some things that made it difficult to determine the impact of this intervention, including the low patient numbers to determine a significant difference on an overall unlikely complication like readmission and the fact that many providers in the group were already performing post-discharge phone calls, so their comparison group was sub-optimal in that respect.
Whenever I read articles like this, I always try to imagine what this would look like if implemented at Riley. While I think the results noted are encouraging, thinking of the possibility of applying this to our practice seems somewhat overwhelming. While I’m not sure of our exact number of discharges per year, I would estimate that it would be up to 3-4 times that of the numbers in this study. The time needed to make all of these phone calls (some of which would undoubtedly require multiple attempts) could quickly become overwhelming on top of the existing demands on our time. One potential way to get around this issue would be to try to identify groups of patients who are at higher risk for difficult transitions and focus on at-risk groups for follow-up phone calls. Issues like this are also part of the reason why we aim to communicate with patients’ PCP after a hospitalization and have children follow-up in the office within a few days after discharge – it would be interesting to know what the typical follow-up plans are for patients from the study group as a follow-up phone call may be less helpful if the patient has already been seen their PCP where they theoretically could have these same concerns addressed.