QR-code Cards for Residents: A Novel Method for Post-ED Visit Follow-up and Reducing Burnout

Abstract

Objective: There is no formal expectation for emergency medicine (EM) residents to follow up on a particular patient after discharge, and it is unknown how residents perceive further contact outside of an Emergency Department (ED) visit. We hypothesize that standardized, dynamic-QR-code embedded cards (“Follow-up Cards”) handed out by residents to patients would provide a means to communicate and follow-up. For select patient encounters, we further hypothesize that residents may derive greater personal accomplishment and meaning from their clinical duties after this intervention. Methods: This was a prospective cohort observational study of 86 residents surveyed on perceptions of follow-up outside of the ED visit as well as the baseline level of burnout using the Copenhagen Burnout Inventory (CBI). Four months after the intervention of “Follow-up Cards”, we reassessed the CBI, quantified the utility of cards via QR code statistics, and surveyed residents’ feedback. Results: There was a 92% response rate to the pre-intervention survey and high internal consistency (𝛼 coefficient = 0.70—0.79) for the 3 domains of the CBI. In terms of perceptions of follow-up, 58.2% deemed it moderately important, 41.8% felt positive about patient communication after an ED visit, and most residents valued learning about the eventual clinical course. Card distribution per resident ranged from 0 to 11 over 4 months. Among interns, patient-related burnout was almost significantly lower after the intervention (27.1 vs 39.3, p = 0.06). “Follow-up Cards” were uniquely scanned by patients 147 times over the 4 months. The primary barriers cited against follow-up were lack of time and increased workload (combined, 75.8%). Conclusions: “Follow-up Cards” were demonstrated in this study as a proof-of-concept and feasible means of patient-physician contact after an ED visit. While follow-up communication was found to be relatively rare overall, there is potential for enriching certain patient encounters.