Next day telephone follow up of the elderly: a needs assessment and critical incident monitoring tool for the accident and emergency department

Abstract

Background-Patients over the age of 75 years comprise an increasing proportion of accident and emergency (A&E) department attendances. Within this group there is a high incidence of comorbidity, which mandates eVective discharge coordination from the A&E department. Objectives-The aims of this study were to assess the needs of these patients the day after discharge, target patients for appropriate interventions and identify critical incidents. Setting-The study was undertaken in a district general hospital A&E department that has 62 000 new patient attendances per year. Inclusion criteria-Patients aged 75 years or over who were discharged from the A&E department. Exclusion criteria-Nursing home patients. Patients without a telephone. Study design-Pre-discharge information was collected from the medical notes. A community liaison nurse (CLN) then contacted patients by telephone. A semistructured questionnaire was used to assess patients. Patients were risk stratified and appropriate interventions made. Interventions initiated by the CLN were scored from 1 to 6 based on the level of input required. Results-551 patients or their carers were contacted by telephone. Existing home support was felt to be insuYcient in 44 (8%) cases and in need of immediate intervention in a further 45 (8%) cases. Sixty five (11%) Category 1 patients required no intervention, 223 (42%) Category 2 patients required advice only, 107 (19%) Category 3 patients were referred to their GP, 127 (23%) Category 4 patients required a domicillary visit by a GP or a nurse, 26 (5%) Category 5 patients were at risk requiring urgent home assessment and three Category 6 patients had to re-attend A&E. Advice was given by the CLN on a broad range of issues and a wide range of health care services was accessed. Five hundred and fifty nine referrals were made by the CLN after telephone assessment. Conclusions-Telephone follow up of patients over 75 attending our A&E department identified a number of areas where care could be improved before and after discharge. This low cost, high quality intervention has the potential for decreasing inappropriate return visits to the department by a vulnerable group of patients as well as improving overall quality of care. (J Accid Emerg Med 2000;17:337-340)

Reduction of 30-Day Preventable Pediatric Readmission Rates With Postdischarge Phone Calls Utilizing a Patient- and Family-Centered Care Approach

“…Similar results were also found by Bean and Waldron (1995), Bowman, Howden, Allen, Webster, and Thompson (1994) and Poncia, Ryan, and Carver (2000). Bean and Waldron (1995) discovered that when a postdischarge phone call was placed 48 hours after discharge, many patients had retained very little of the discharge information taught to them prior to leaving the hospital.…”

The elderly in the emergency department: a critical review of problems and solutions

“…For example, second-level CGA (performed in the ED [82,83] or, within 24 hours, at the patient's home [89]), individualised discharge plan or case management by specialised nurses or a multidisciplinary team [83,89,90], appropriate referral for primary care and community services [82,83,91], and follow-up [82,83] with ambulatory or home visit or telephone contact [92,93] have been used. Unfortunately, the paucity of randomised controlled clinical trials, together with the great variability in the type of intervention, study design (e.g., patient selection, duration of interventions and follow-up, considered outcomes) and compliance to recommended programs, can probably account for the lack of consistent results.…”

Social care's impact on emergency medicine: a model to test

“…28 Identifying the need for services One factor that may affect rates of emergency re-attendance or readmission is the capacity of ED staff to identify the need for a range of further services in patients who are not admitted or discharged. For example, when Poncia et al 29 reported a study in which 551 patients over 75 or their carers were contacted by telephone the day after discharge from an A&E department substantial unmet needs were discovered. Existing home support was felt to be insufficient in 44 (8%) cases and in need of immediate intervention in a further 45 (8%) cases.…”

“…As has just been indicated above [29][30][31][32][33][34] a range of circumstances that lead people to ED attendance are as much social as medical in nature and origin: self harm, violence (including domestic violence and child abuse), substance misuse, the lack of adequate social care. In addition, it is known that material deprivation is associated with raised rates of ED attendance and emergency hospital admission.…”