Facilitating Follow-Up after Emergency Care Using an Appointment Assignment System

Abstract

Many emergency department (ED) patients require urgent follow-up in primary care. The most effective way to help patients obtain their needed after-visit care is to secure the appointment on their behalf prior to their departure from the ED. This study describes the development, implementation, and outcomes of an appointment assignment system that facilitates patient follow-up at two community hospitals in an integrated healthcare system. This patient-centered system resulted in a high rate of compliance and a very low rate of unscheduled ED recidivism. Improving access in this manner will likely strengthen the continuum of care, improve quality, and increase patient satisfaction.

The Transition of Care Between Emergency Department and Primary Care: A Scoping Study

“…Papers in the Follow-up compliance and its predictors theme group assessed the frequency of follow-up care among discharged ED patients, as well as the factors (some adjusted, some univariate) associated with obtaining follow-up care. For organizational purposes, we further subdivided papers into general follow-up compliance and its predictors (13 papers), 17,18,20,23,30,32,33,37,39,40,42,43,47 those specifically for patients with asthma (11 papers), 16,21,25,28,41,45,[48][49][50]52,53 studies that provided an appointment (date and time) prior to ED departure (11 papers), 22,26,27,29,31,[34][35][36]44,46,51 and studies that provided an appointment but not during the ED visit (three papers). 19,24,38 As shown in Table 4, the provision of an outpatient follow-up appointment prior to ED discharge was tested in five randomized controlled trials (RCTs).…”

“…Multiple studies have shown an association between obtaining timely follow-up care and better subsequent patient outcomes, but all of these studies limited their patient inclusion criteria to specific groups (those with heart failure, atrial fibrillation, and low-risk chest pain). [107][108][109][110][111] Patient selection criteria among all the studies included in our scoping study varied widely: some studies included all discharged patients (no risk stratification was applied), [34][35][36]42,47,57,[59][60][61]63,65,66,69,71,72,75,76,80,92,93,97 others limited the cohort to patients with certain diseases (e.g., asthma, hypertension) or acute conditions that would reasonably require follow-up care (e.g., possible ectopic pregnancy, low-risk chest pain patients), [16][17][18][19]21,[24][25][26]28,32,33,38,39,41,[43][44][45][46]…”

Managing Emergency Department Patients with Recent-onset Atrial Fibrillation

“…The reasons listed by the treating physician for not attempting cardioversion (more than one reason could be noted) included frequent recurrences of atrial dysrhythmia (n = 14; 93.3%), relevant comorbidities or sedation risk (n = 9; 60.0%), and prior failed cardioversion attempt (n = 2; 13.3%). The majority of these patients received IV rate reduction medication in the ED (Table 3) and was discharged home (Table 4) on rate-control medications and anticoagulation with arranged timely follow-up with their primary care provider or cardiologist (14). Because this group of patients was thought to be ineligible for cardioversion, they were not advised to return to the ED within 48 h of symptom onset as in the ''short-term home observation'' group.…”

“…This would allow sufficient time for attempted cardioversion within the 48-h window for those who might fail to spontaneously convert. Eleven of these home observation patients were instructed to return directly to the ED, and 5 were arranged urgent follow-up in the clinic (3 in the Cardiology Clinic and 2 with their primary care provider) (14). All 16 patients returned as directed and 11 (68.8%) were found to have spontaneously converted.…”

Factors associated with failure to follow up with a general practitioner after discharge from the emergency department

“…If patients who are unlikely to comply with follow up can be identified while still in the ED, the management plans for these individuals could be tailored to their specific needs or circumstances. This might help ensure the successful completion of their therapy and prevent adverse outcomes or representation to the ED …”