Improving Telephone Contact of ED Patients
ABSTRACT & COMMENTARY
Source: Isaacman DJ, et al. A simple intervention for improving telephone contact of patients discharged from the emergency department. Pediatr Emerg Care 1997;13: 256-258.
Investigators from the children’s hospital of Pittsburgh and the Children’s Hospital of Wisconsin set out to determine whether ED follow-up contact rates can be improved by confirming a best contact telephone number with the patient prior to discharge. Over a period of two years at these two urban hospitals, Isaacman et al compared a convenience sample of "intervention" patients (total 188) with a "grab sample" of control patients (total 305). The intervention consisted of the investigator directly asking the guardians for a telephone number where they could be reached the following day to check on the child’s condition and relay any outstanding laboratory results. The number used to contact the control group was the telephone number listed on the ED record. The registration process at both institutions was similar and included checking and updating existing demographic data in the hospital’s information system if the patient had been seen previously. Follow-up calls were made to both groups within 24 hours.
Fifteen percent of the intervention group gave a number that differed from that on the ED chart. Ninety-four percent of the guardians in the intervention group were successfully contacted, compared with 81% of the control group (P £ 0.001). Reasons for no contact in the intervention group included no answer after three calls (8), wrong number (1), and disconnected number (1). Reasons for no contact in the control group included no answer after three calls (34), disconnected number (13), wrong number (10), and change to unlisted number (1).
COMMENT BY LEONARD FRIEDLAND, MD
As I read this article, I couldn’t resist saying "been there." Nothing is more frustrating than spending time fruitlessly trying to track down a family to relay laboratory or radiology results. In recent years, our practice reflects growing outpatient management, and, thus, we are doing more follow-up. Previous reports have documented that follow-up contact of ED patients is often not successful; in particular, I would like to draw your attention to a 1992 report in which the ED was able to contact, by telephone, only 85% of parents whose children had a positive blood culture.
These data show that a simple interventionasking the guardian for a contact telephone number prior to dischargecan increase the successful contact of ED patients. When follow-up is necessary, we should ask, "When is the best time to call?" I now ask the guardian or adolescent for their pager number; this is a sure-fire number, and most of my patients in Philadelphia seem to have one.
Reference
1. Joffe M, Avner JR. Follow-up of patients with occult bacteremia in pediatric emergency departments. Pediatr Emerg Care 1992;8:258-261.
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