Telephone follow-up to reduce unplanned hospital returns for older emergency department patients: A randomized trial.

Abstract

BACKGROUND/OBJECTIVES\nTelephone follow-up calls could optimize the transition from the emergency department (ED) to home for older patients. However, the effects on hospital return rates are not clear. We investigated whether telephone follow-up reduces unplanned hospitalizations and/or unplanned ED return visits within 30\u2009days of ED discharge.\n\n\nDESIGN\nPragmatic randomized controlled trial with allocation by month; odd months intervention group, even months control group.\n\n\nSETTING\nTwo ED locations of a non-academic teaching hospital in The Netherlands.\n\n\nPARTICIPANTS\nCommunity-dwelling adults aged ≥70\u2009years, discharged home from the ED were randomized to the intervention group (N\xa0=\xa04732) or control group (N\xa0=\xa05104).\n\n\nINTERVENTION\nIntervention group patients: semi-scripted telephone call from an ED nurse within 24\u2009h after discharge to identify post-discharge problems and review discharge instructions. Control group patients: scripted satisfaction survey telephone call.\n\n\nMEASUREMENTS\nPrimary outcome: total number of unplanned hospitalizations and/or ED return visits within 30\u2009days of ED discharge.\n\n\nSECONDARY OUTCOMES\nseparate numbers of unplanned hospitalizations and ED return visits. Subgroup analysis by age, sex, living condition, and degree of crowding in the ED at discharge.\n\n\nRESULTS\nOverall, 42% were males, and median age was 78\u2009years. In the intervention group, 1516 of 4732 patients (32%) consented, and in the control group 1659 of 5104 (33%) patients. Unplanned 30-day hospitalization and/or ED return visit was found in 16% of intervention group patients and 14% of control group patients (odds ratio 1.16; 95% confidence interval: 0.96-1.42). Also, no statistically significant differences were found in secondary outcome measures. Within the subgroups, the intervention did not have beneficial effects for the intervention group.\n\n\nCONCLUSION\nTelephone follow-up after ED discharge in older patients did not result in reduction of unplanned hospital admissions and/or ED return visits within 30\u2009days. These results raise the question of whether other outcomes could be improved by post-discharge ED telephone follow-up.