Simple follow-up calls prevent poor outcomes
Results are potentially lifesaving
As patient volume in the ED at Stanford (CA) Hospital & Clinics increased, charge nurses had less time to follow up with discharged patients. For this reason, a callback program was implemented, with designated nurses calling patients from 9 a.m. to 9 p.m., seven days a week, says Karen Stuart, RN, BSN, CEN, BSN, the ED assistant nurse manager who helped to launch the program.
Previously, the triage nurse had to follow up on culture reports in between patients, while charge nurses followed up on X-ray rereads. However, Stuart says that "uninsured or medically unsophisticated patients may get lost in the process" with this method.
Now, the callback nurses ensure that patients understand their follow-up instructions, and make sure they have the proper follow up. "For instance, did the doctor refer them to the right clinic and can they get an appointment? This is especially important with the elderly and noninsured," says Mary K. Durando, RN, BSN, CEN, one of the callback nurses.
The nurses also make sure that patients were able to obtain whatever medications they were subscribed. "If they need help with buying a medication, we can refer them to the proper resources," says Durando.
Patients told of abnormal result
Stanford's callback nurses have found abnormal cultures that someone missed, and notified patients immediately. For example, a cancer patient came in with low grade fever and abdominal pain, and a positive blood culture result came back 18 hours after her visit.
"For a cancer patient, sepsis can be fatal," says Durando. "I was able to contact the on-call resident for the oncology service within minutes. The patient was admitted as an inpatient several hours later." If your ED doesn't have the resources for a callback program, Durando recommends the following:
- Look at patient flow times to identify "down times' or slower periods during the day to follow up calls. "If you have electronic charting, routing the referrals directly to the clinic may work best for you," Durando says.
- Include clear instructions for how to obtain follow-up care when a patient is discharged.
- Have a mechanism in place to notify clinics affiliated with ED of referrals given to patients. "Special attention should be paid to the uninsured, underinsured, worker's comp, children, and the elderly," says Durando.
Source
For more information about the ED's callback program, contact:
- Mary K. Durando, RN, BSN, CEN, Emergency Department, Stanford (CA) Hospital & Clinics. Phone: (650) 725-4492. Fax: (650) 736-7603. E-mail: [email protected].
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