Postdischarge problems identified by telephone calls to an advice line

Area of Science:

• Healthcare Management
• Patient Safety
• Clinical Informatics

Background:

• Post-hospital discharge complications frequently lead to rehospitalizations and unplanned urgent care.
• Effective discharge planning is crucial for patient recovery and preventing adverse events.

Purpose of the Study:

• To analyze calls made to an advice line (AL) to identify specific areas for improving hospital discharge processes.
• To understand the nature of patient issues arising after discharge and their correlation with adverse outcomes.

Main Methods:

• Prospective cohort study conducted at a 500-bed university-affiliated hospital.
• Analysis of calls received by an AL from patients hospitalized or undergoing outpatient surgery within 30 days prior to the call, over a one-year period.
• Data collected included caller demographics, call timing, and the nature of reported problems.

Main Results:

• Over 308 unique patients called the AL within 30 days of discharge or surgery.
• A significant proportion of calls (31% and 47%) occurred within 24 and 48 hours post-discharge, respectively.
• Surgery patients generated a disproportionately high number of calls (63%). Common issues included pain management, medication queries, and surgical wound care.
• Patients who called the AL had higher rates of 30-day readmission (15% vs. 4%) and urgent/emergent care visits (30% vs. 7%) compared to non-callers.

Conclusions:

• Patient-initiated calls to an advice line (AL) reveal critical deficiencies in hospital discharge processes.
• These calls identify specific patient needs related to pain control, medication understanding, and post-operative care instructions.
• Patients contacting the AL post-discharge are at a demonstrably higher risk for subsequent rehospitalization and urgent care utilization.