Face-to-Face Meetings with Neurosurgical Patients Before Hospital Discharge: Impact on Telephone Outreach, Emergency Department Visits, and Hospital Readmissions

Abstract

The Johns Hopkins Community Health Partnerships ( JCHiP) was developed in 2010 within the Johns Hopkins Health Systems. As part of JCHiP, the Patient Access Line call center was created. The average telephone reach rate at The Johns Hopkins Hospital in 2014 was only 53%. In a population of adult neurosurgical patients, this study aimed to: determine the impact of face-to-face meetings with neurosurgical patients before hospital discharge on telephone follow-up (TFU) reach rates, and determine the association between TFU reach rates and subsequent emergency department (ED) visits and hospital readmission rates. This quasi-experimental study used a posttestonly research design with a comparison group. Two adult inpatient neurosurgical units at the Johns Hopkins Hospital were selected as the intervention and comparison groups. A convenience sampling technique was used. Face-to-face meetings pre hospital discharge resulted in a TFU reach rate of 97.7% on the intervention unit while the comparison unit had only a 76.1% TFU reach rate (P < .001). Reached patients had fewer ED visits (7.8%) than not reached patients (17.4%); however, the difference was not statistically significant (P = .138). Reached patients also had fewer hospital readmissions (3.3%) than not reached patients (8.7%); this also was not statistically significant (P = .214). This study demonstrated that face-to-face meetings with neurosurgical patients prior to discharge increased TFU rates. Results were statistically significant. ED visits and hospital readmissions were also reduced in reached patients and the findings were clinically significant.

Predictors for Telephone Outreach Post-hospital Discharge

“…The intervention group that received face-to-face meeting interventions had a higher TFU reach rate (97.7%; n = 86; p = .000) compared with the control group (76.1%; n = 67) that did not receive face-to-face meeting interventions in the prospective posttest-only quasi-experimental study conducted by Vergara et al (2020). In addition, the majority of the patients in the intervention group answered the TFU during the first attempt and demonstrated statistical significance (71.6%; n = 63; p = .001) compared with the control group (42%; n = 37) that did not receive a face-to-face meeting intervention (see Table 3).…”

“…A prehospital discharge face-to-face meeting was implemented on the intervention unit. Vergara et al (2017Vergara et al ( , 2020 developed the essential components of a prehospital discharge face-to-face meeting intervention (see Figure 2) using a telephonic case manager (see Figure 3).…”

“…As described in a recent study by Vergara et al (2020) , the participants received the face-to-face meetings prehospital discharge (see Figure 2 ). The case manager:…”

“…• the best phone number(s) to reach the patient; • the best time and date for TFU; and • a reminder of paperwork and items needed at the time of the telephone call ( Vergara et al, 2020 ). "…”

“…Improving TFU reach rate is very signifi cant in the success of a telephonic case management program because evidence suggests ( Hoyer et al, 2018 ) that patients reached by the TFU after hospital discharge prevented 777 readmissions and saved a health system of approximately $11.8 million within 40 months. Several studies also demonstrated that successfully reaching patients posthospital discharge may decrease ED visits and hospital readmission due to a bundle of posthospital interventions during the telephone call (Kind et al, 2016;Vergara et al, 2020 ). The face-to-face meeting intervention demonstrated its signifi cance to transitions of care because if case managers were unable to contact patients' posthospital discharge, it would be challenging to deploy posthospital discharge interventions.…”