The moment of discharge following a long-term stay in a pediatric inpatient unit is emotional and chaotic. It is a huge relief for families to take their child home, but it can also be nerve-wracking to leave the safety of the hospital. The verbal instructions and bundle of paperwork received at discharge provide reassurance, but as families settle back in at home, their recollection of these important details can become hazy. Many hospitals have found that the best way to reengage families with their child’s care plan and increase patient adherence is to have familiar nurses or other advanced practice providers (APPs) from the unit follow up by phone within a few days of discharge. This practice has several key benefits:
1. Reduced Readmission Rates
Although children’s hospitals are not yet subject to the federal government’s penalties for preventable readmissions, many common quality measures endorsed by the National Quality Forum capture this data, and policy changes creating financial ramifications are not far behind. Hospitals treating children should be taking the same precautionary measures as those treating adults. They need to proactively ensure that patients do not return to the hospital or visit the ED unnecessarily following an inpatient stay. Having an APP call within 72 hours to review follow-up care improves the family’s understanding of discharge instructions and ensures early intervention in cases where a pediatric patient’s condition worsens – enhancing the overall quality of care and reducing the risk of preventable readmissions.
2. Better Patient Compliance and Follow-Up
Many families don’t fully comply with discharge instructions for their child, not out of neglect, but simply because they don’t remember all the details of the aftercare plan or didn’t understand them in the first place. Post-discharge follow-up calls give the family the opportunity to ask clarifying questions in a calmer environment and to review clinical instructions or medications, resulting in better compliance. They also ensure that follow-up appointments are scheduled promptly, and that patients are given in-network referral options to stay within the system for specialized follow-up care. With centralized scheduling systems, the family members can even be directly transferred to another scheduler at the end of the call.
3. Improved Feedback Loop
Post-discharge calls also help improve pediatric care by collecting timely feedback about a family’s interactions with providers and their child’s care in advance of traditional patient satisfaction surveys, which are administered approximately 1 month or more after discharge. Given this lag, response rates are low and the feedback is often provided in a contextual vacuum, with comments sufficiently vague that staff can’t tie them back to specific events or individuals. Timely follow-up calls make for a more complete picture of the family experience and allow providers to ask questions that provide context, functioning as a helpful supplement to traditional satisfaction surveys.
4. Opportunity to Respond to Feedback
The lag time and other issues associated with the patient satisfaction survey also make it challenging for the care team to address the issues directly with a patient’s family and to turn negative feedback into a positive learning opportunity for the medical staff. But when APPs from the unit call families shortly after a child’s inpatient stay, the family’s concerns can be immediately addressed and the feedback can be acted upon quickly. Unit leaders can review scenarios with the care team while they are still fresh in their minds, conduct root cause analyses or process improvement exercises, and then take action to improve provider/family and provider/patient interactions.
5. Higher Patient Satisfaction Scores
Hospitals that adopt the practice of post-discharge follow-up calls can expect to see improved patient satisfaction scores. The personal element of the call goes a long way – especially when it comes from a provider with whom the family interacted during the hospital stay. The familiar staff member can offer timely resolution in the immediate aftermath of a negative experience, either by bringing in someone more senior or by simply offering an apology on behalf of the hospital. Post-discharge calls allow families to express their concerns and be heard before the traditional surveys are received, and the scores tend to improve to reflect this additional effort.
Stay tuned for a second post that shares best practices for pediatric post-discharge follow-up calls, offers tips based on our clients’ experience, and even provides a sample call script.
Published July 12, 2016