I think most of us would agree that it’s a good idea to do discharge follow-up calls to patients, and yet it’s the rare healthcare organization that does it consistently (and well). I’ll admit that I am a bit of an idealist when it comes to discharge follow up, but if we are really going to deliver truly patient-centered care, we need to have some ideals.
Nurses and healthcare leaders often talk about the high level of acuity among today’s inpatients. In addition, they have shorter length of stay. To me, those two facts alone indicate the greatest need for follow-up calls to be made within 24 – 48 hours of discharge. That’s when patients have questions, and that’s when they need reassurance, advice, and reinforcement of information provided. Not to mention that readmissions are costly and are going to be even more costly to hospitals in the future.
Most leaders say that they would love to be more consistent in their follow-up calls. But interviews with nurse leaders revealed that the main reason for not making discharge calls is manpower. It takes personnel to do the calls, and, given a fixed staff, direct patient care will trump follow-up calls every time. It’s frustrating for the leader and the staff. Units are usually staffed to manage the care needed for the patients in the beds, leaving little if any latitude for personnel dedicated to follow-up calls. The upshot is that discharge calls are seen as nice but not necessary. It’s time to change that thinking, especially since early intervention on problems could prevent unnecessary and costly readmissions.
Let’s get clear about why discharge calls need to be done. I see three primary objectives for the calls. First and foremost, it is to check on the patient’s condition and to support discharge instructions when needed. That support can make the difference in clinical outcomes linked to comprehension of the instructions as well as compliance. In addition to that, discharge calls help to maintain a positive connection with the hospital. It imparts the message that, although you (the patient) are no longer in our direct care, we are concerned about your well-being and are staying connected with you.
The third objective for discharge calls is service spotlight and recovery. CMS regulations prohibit hospitals from asking HCAHPS questions in advance of the HCAHPS survey, so although you don’t want to overlap with the HCAHPS survey, it is still a good idea to seek patient perceptions about the experience. This will help you to take action on issues that can be fixed and to thank the service stars who exemplify your values.
Too many hospitals are putting off discharge calls or making them sporadically when they have staff available. It’s time to dedicate resources to discharge calls. If you don’t have the manpower to make the calls, you can outsource the calls. Beryl is a company that is managing discharge follow-up calls for a number of hospitals. While some hospitals feel that the call must be made by a nurse, the research demonstrates that less than 5 percent of all discharge calls require any clinical advice.
When patients leave the hospital, they are often scared, vulnerable, and uncertain about next steps. In many cases, instructions are reviewed with them while they are feeling poorly or under the influence of medication. If we are to be patient-centered, then we need to dedicate time and attention to the patients’ needs. Discharge follow-up calls can improve compliance and, ultimately, clinical outcomes. In addition, they send a message that the hospital and providers care enough to have someone on their team make a call (and, yes, even outsourced callers are part of your team). To me, it’s no longer an issue of whether or not calls should be made; it’s how you’re going to make it happen. To borrow from Nike, “Just do it!”