Improving Follow‐up Attendance for Discharged Emergency Care Patients Using Automated Phone System to Self‐schedule: A Randomized Controlled Trial

Abstract

Background Automated phone appointment reminders have improved adherence with follow‐up appointments in a variety of hospital settings, but have mixed results in patients discharged from the emergency department (ED). Increasing adherence to follow‐up care has been a priority in the ED to improve patient outcomes and reduce unnecessary future visits. Methods We conducted a prospective randomized open, blinded end‐point (PROBE) trial of 278 adult patients discharged from the ED and referred to a provider for follow‐up care. Participants in the intervention arm received a self‐scheduling text or phone message that automatically connected them to their referral provider to schedule a follow‐up appointment and sent them appointment reminders. Those in the control arm received standard‐of‐care written instructions to contact listed referral providers. The primary outcome was time to appointment. The secondary outcome was time to return visit to the ED. Results The automated reminders increased the cumulative incidence of keeping the referral appointment after ED discharge (p < 0.001, Gray's test). Of participants randomized to the automated phone intervention, 49.3% (n = 74) kept their follow‐up appointment versus 23.4% (n = 30) in the control arm, with a hazard ratio (HR) and 95% confidence interval (CI) over the duration of the study period of 2.4 (1.6 to 3.7; p < 0.001). In a sensitivity analysis using 30 days of follow‐up data, 42.0% (n = 63) of participants randomized to the phone intervention kept their follow‐up versus 21.1% (n = 27) in the control arm, with a HR (95% CI) of 2.2 (1.4 to 3.5; p < 0.001). There was no difference in ED revisits between the intervention and control group within 120 days postdischarge. Conclusions An automated self‐scheduling phone system significantly improved follow‐up adherence after ED discharge, but did not decrease ED revisits.

Effectiveness of a care transitions intervention for older adults discharged home from the emergency department: A randomized controlled trial

“…Across delivery methods and formats, interventions to improve care transitions have been much more successful at improving outpatient clinical follow‐up or adherence behaviors/outcomes than ED re‐visitation, regardless of the time frame measured 15,20,21,40 . A 2020 meta‐analysis by Aghajafari et al, 20 involving 20 randomized controlled trials of ED‐based interventions for improving care transitions, found 79% increased odds of outpatient follow‐up overall, but no significant treatment effects on ED utilization or hospitalization.…”

Postendoscopy Care for Patients Presenting With Esophageal Food Bolus Impaction: A Population-Based Multicenter Cohort Study

“…Systematic quality improvement measures targeting the appropriateness of postendoscopy care and follow-up after an esophageal FBI should be considered. A previous trial showed that the use of an automated phone and text messaging system allowing patients to schedule follow-up appointments immediately after ED discharge resulted in a 25.9% improvement in follow-up adherence (25). Previous studies have also demonstrated that the incorporation of a standardized patient navigator, who helps guide patients through the health care system by communicating with other providers, setting up appointments, and accessing community resources, results in improved follow-up (26).…”