February 20, 2018 | Susan Pasley, MS, BSN, RN
Discharge: Support (Part 3 of 5)
Patients who present to your emergency department are typically suffering and anxious about the events that led them to seek medical care. As previously discussed, this stressful state can impair the patients’ ability to understand all critical aspects of their diagnosis and treatment plan. Providing follow-up support both while the patient is in your department as well as after they leave can significantly decrease the likelihood of a discharge failure. Support can include medication management, procurement of follow-up appointments and provision of resources that will increase the rate of compliance.
Follow-up telephone calls by a nurse, provider or case manager have been shown as an effective strategy for improving the patient experience and improving treatment plan outcomes. While many patients have an email address in this age of technology, research shows that, in general, a telephone call remains a more effective way to communicate than email. Follow-up calls should be conducted using a standardized template that addresses key aspects of compliance including fielding questions, medication adherence, securing provider and testing appointments, and the patient experience. Calls should be made within 24-48 hours, and clinicians should have access to the medical record during the outreach. Information should be tracked in a software program or log to trend for process improvement initiatives. Successful implementation of a comprehensive program can result in improved patient experience, increased referral provider follow-up and improved disease management.
Follow-up text messages
The prevalence of cellular technology presents an alternative or adjunct to traditional telephone calls for effective follow-up support. The Pew Center reported in 2017 that 95 percent of adults in the United States have a cell phone and 77 percent own a smart phone with internet capabilities. Similar findings are present in the ED patient population. Two 2013 studies found that in urban EDs 82 percent of patients and visitors and 90 percent of pediatric caregivers owned a cell phone. Of the 102 pediatric caregivers surveyed, 87 percent stated that they check their text messages daily. This technology provides you with another way to reach patients for both follow-up adherence and disease management. A study at Los Angeles County Medical Center found an overall increase in post discharge follow-up attendance in patients who received uni-directional text message appointment reminders. In another research study, A1C levels decreased with increased medication adherence in ED patients with poorly controlled diabetes who received daily text messages over a six-month timeframe. There is great potential in using this technology as part of an inclusive engagement strategy.
Patients fail to comply with the prescribed medication regime when they do not understand the need for the medicine, lack insurance or funds to pay, or lack transportation to name a few reasons. As this is an important component of the treatment plan, you have an opportunity to help patients remove barriers to compliance. This can be accomplished by addressing the subject at every touch point in your engagement strategy. Ensuring that patients understand the need for the pharmacological intervention and how to take the medication should be incorporated into your education and teach back. In addition, utilize telephone call backs and text reminders to address adherence after the patient leaves your department. Work with case management to determine if there are prescription assistance programs in your area. Offer prescription discount cards at discharge or during follow-up interventions. Many national and regional pharmacies offer antibiotics and other common medications at no charge or reduced costs. Ensure that your patients have access to a list of reduced medication programs in your area.
Scheduling follow-up appointments prior to discharge
There are a wide variety of factors that contribute to patients’ failure to make and keep follow-up primary care and specialty appointments. These range from transportation issues to perceived improvement in condition to simply forgetting. However, ensuring that patients continue to seek appropriate care outside of the ED is imperative to overall health, quality of life and reducing unnecessary ED visits. Patients who leave the ED with provider and testing appointments already secured have an increased rate of compliance. While manually making appointments can be a time and labor-intensive process, technology companies are actively seeking effective and efficient ways to automate this process.
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