Telephone Follow‐Up for Older Adults Discharged to Home from the Emergency Department: A Pragmatic Randomized Controlled Trial. Issue 3 (22nd December 2017)

• Record Type: Journal Article
• Authors: Biese, Kevin J.; Busby‐Whitehead, Jan; Cai, Jianwen; Stearns, Sally C.; Roberts, Ellen; Mihas, Paul; Emmett, Doug; Zhou, Qingning; Farmer, Franklin; Kizer, John S.
• Is Part Of: Journal of the American Geriatrics Society. Volume 66:Issue 3(2018)
• Page Start: 452
• Page End: 458
• Publication Date: 2017-12-22
• Subjects: emergency medicine -- care transitions -- rehospitalization in elderly; Geriatrics -- Periodicals; 618.97
• DOI: 10.1111/jgs.15142
• Languages: English
• ISSNs: 0002-8614

Abstract

Abstract : Background/Objectives: Telephone calls after discharge from the emergency department (ED) are increasingly used to reduce 30‐day rates of return or readmission, but their effectiveness is not established. The objective was to determine whether a scripted telephone intervention by registered nurses from a hospital‐based call center would decrease 30‐day rates of return to the ED or hospital or of death. Design: Randomized, controlled trial from 2013 to 2016. Setting: Large, academic medical center in the southeast United States. Participants: Individuals aged 65 and older discharged from the ED were enrolled and randomized into intervention and control groups (N = 2, 000). Intervention: Intervention included a telephone call from a nurse using a scripted questionnaire to identify obstacles to elements of successful care transitions: medication acquisition, postdischarge instructions, and obtaining physician follow‐up. Control subjects received a satisfaction survey only. Measurements: Primary outcome was return to the ED, hospitalization, or death within 30 days of discharge from the ED. Results: Rate of return to the ED or hospital or death within 30 days was 15.5% (95% confidence interval (CI) = 13.2–17.8%) in the intervention group and 15.2% (95% CI = 12.9–17.5%) in the control group ( P = .86). Death was uncommon (intervention group, 0; control group, 5 (0.51%), 95% CI = 0.06–0.96%); 12.2% of intervention subjects (95% CI = 10.1–14.3%) and 12.5% of control subjects (95% CI = 10.4–14.6%) returned to the ED, and 9% of intervention subjects (95% CI = 7.2–10.8%) and 7.4% of control subjects (95% CI = 5.8–9.0%) were hospitalized within 30 days. Conclusion: A scripted telephone call from a trained nurse to an older adult after discharge from the ED did not reduce ED or hospital return rates or death within 30 days. Clinicaltrials.gov identifier: NCT01893931z. Abstract : See related editorial byHwang et al .