Purpose: The purpose of this project was to reduce hospital readmissions for post-operative otolaryngology (ENT) patients discharged to home through the implementation of nurse-to-patient post-discharge phone calls. Post-operative otolaryngology patients have complex discharge planning requirements, including the need for home care, equipment and supplies, and detailed patient/family teaching. The risk for complications is high, and emergency department (ED) visits and/or hospital readmissions are not uncommon in this patient population.
Description: The unit leadership recognized the need for follow-up calls to patients on discharge day 2 to confirm that ongoing care have been properly addressed. The call confirms that ongoing care needs have been properly addressed: home care nurse visits are arranged, supplies are delivered, prescriptions are filled, and post-operative appointments are scheduled with the providers. It also provides an opportunity for the patient/caregiver to express concerns about patient’s care and condition. The responses can be categorized as: no issues (offered reassurance), nursing care (provided patient and family education), medical problems (routed to the physician team), logistical concerns (contacted home health care), or urgent evaluation (referred to the emergency department or outpatient ENT clinic). The charge nurse recognized when there is a need to escalate the call to the ENT intern, ENT clinic, home care liaison, etc. It is important to have consistency within the charge nurses making the phone calls. We provided charge nurse educational sessions and worked with the unit-based hospital unit clerk (HUC) to populate demographics to the follow-up tool. We also worked with the physician unit partner (PUP) to obtain dedicated ENT clinic access for patients that may need to be seen prior to their scheduled post-discharge appointments. The quality indicators for this project are the otolaryngology (ENT) 7-day readmission rate and monthly post-discharge call data.
Outcomes/evaluation: This project began in 2018 and has continued with a remarkable decrease in readmission rates. The 2018 (baseline) mean 7-day readmission rate was 7% (range 4-15%). The 2019 (post-implementation) mean 7-day readmission rate was 5% (range 3-15%) Through focused calls to the patients and families, the 2020 (sustained 0-mean readmission rate was 2.80% (range 0-8%). The 2020 mean number of monthly post-discharge phone calls was 32.1 (range 18-51). Post-intervention calls correlated with reduced readmission rates.
Ongoing: We continue to evaluate the discharge follow-up tool for effectiveness, streamline the data collection process, encourage input from charge nurses, audit charge nurses to ensure consistency with follow-up phone calls, and update the unit staff on the progress of the project and the significance of in-depth patient education.