Telephone follow‐up to reduce unplanned hospital returns for older emergency department patients: A randomized trial

Abstract

Background/Objectives: Telephone follow-up calls could optimize the transition from the emergency department (ED) to home for older patients. However, the effects on hospital return rates are not clear. We investigated whether telephone follow-up reduces unplanned hospitalizations and/or unplanned ED return visits within 30 days of ED discharge. Design: Pragmatic randomized controlled trial with allocation by month; odd months intervention group, even months control group. Setting: Two ED locations of a non-academic teaching hospital in The Netherlands.Participants: Community-dwelling adults aged ≥70 years, discharged home from the ED were randomized to the intervention group (N = 4732) or control group (N = 5104). Intervention: Intervention group patients: semi-scripted telephone call from an ED nurse within 24 h after discharge to identify post-discharge problems and review discharge instructions. Control group patients: scripted satisfaction survey telephone call.Measurements: Primary outcome: total number of unplanned hospitalizations and/or ED return visits within 30 days of ED discharge. Secondary outcomes: separate numbers of unplanned hospitalizations and ED return visits. Subgroup analysis by age, sex, living condition, and degree of crowding in the ED at discharge. Results: Overall, 42% were males, and median age was 78 years. In the intervention group, 1516 of 4732 patients (32%) consented, and in the control group 1659 of 5104 (33%) patients. Unplanned 30-day hospitalization and/or ED return visit was found in 16% of intervention group patients and 14% of control group patients (odds ratio 1.16; 95% confidence interval: 0.96-1.42). Also, no statistically significant differences were found in secondary outcome measures.

Frequencies and reasons for unplanned emergency department return visits by older adults: a cohort study

“…The trial was conducted in the EDs of Haaglanden Medical Center (HMC), a non-academic teaching hospital in the Netherlands, from February 1, 2018 to July 1, 2019. In this RCT, 3175 patients were allocated to either the intervention ( n = 1516) or the control ( n = 1659) group, according to the month of their ED visit; patients included in odd months received an intervention telephone call to identify post-discharge problems and to offer additional information, and patients included in even months received a satisfaction survey telephone call [ 20 ]. The Medical Ethics Review Committee of HMC waived the necessity for formal approval of the study as it closely followed routine care (METC Zuidwest Holland, nr.…”

“…Patients aged ≥ 70 years who were discharged from one of the EDs of HMC to an unassisted living environment were eligible for inclusion. Exclusion criteria were: admission to the hospital, discharge to a nursing home, another care facility or assisted living environment, and planned follow-up appointment at an outpatient clinic or at the ED within 24 h [ 20 ].…”

“…We also used data concerning level of ED crowding at discharge, measured by the National Emergency Department OverCrowding Scale (NEDOCS) [ 25 ]. Data were abstracted from the EHS by an information technology specialist, who was not involved in the study [ 20 ].…”

“…However, systematic reviews evaluating the effects of post-discharge interventions initiated in the ED have found that many were not effective in reducing ED re-attendances [ 8 , 9 ]. In a pragmatic randomized controlled trial, our research group also failed to find a beneficial effect of a transitional care program, consisting of post-ED discharge telephone follow-up for older adults, on the reduction of unplanned hospital admissions and URVs within 30 days after ED discharge [ 20 ].…”

Emergency Department Care Transition Programs—Value-Based Care Interventions That Need System-Level Support

“…Although prior studies of ED-directed callback programs have shown that they can improve outpatient follow-up, the association of these programs with ED revisit rates and hospitalization rates have been mixed. Like Fruhan and Bills, Luciani-McGillivray et al found that their program decreased the number of unplanned ED revisits, whereas other callback programs had no association with ED revisits, hospitalizations, or costs of care . Future research is needed to understand this variation.…”