Implementing Standardized Post-Surgical Follow-Up Calls in Outpatient Surgery

Abstract

Problem: A community hospital post-anesthesia care unit (PACU), performing 70-100 outpatient surgeries per week, completed 40% of eligible telephone follow-ups (TFUs) secondary to inconsistent nursing workflow and lack of an evidence-based TFU script. Purpose: This quality improvement (QI) project implemented the evidence-based Re-Engineering Discharge Tool-5 (RED-5) and a formal delegation process in the PACU. Methods: Over a 16- week period in the Fall of 2023, the RED-5 script was made available to nursing staff on paper and electronically. Twenty staff nurses were trained with a 1:1 simulation. Weekly audits of delegation, calls attempted/completed, RED-5 adherence, appointment status, and escalations were completed. Project progress was shared with stakeholders through a unit tracking board, staff huddles, and monthly meetings. Run charts were used to demonstrate process adherence. Results: The new delegation process was documented 40% (n=29) of 72 eligible weekdays. In total, 1435 outpatients were discharged from the PACU. Thirty-four percent (n=494) of calls were attempted. Of the 23% (n=324) of calls completed, 71% (n=231) adhered fully or partially to the RED-5 script. Eighteen percent (n=59) required either one or both, clarification of discharge instructions (n=44) and surgeon referral (n=34). No patient was referred to the emergency department (ED). Of the 213 patients assessed, 30% of patients (n=63) had not scheduled follow-up appointments. Conclusions: Implementing the standardized RED-5 script improved postoperative identification of patient needs. Next steps involve collaborating with Information Technology (IT) and management to embed the RED-5 TFU script into the TFU application. During the project implementation period no change was noted in calls attempted or completed. Modifications to workflow processes are needed to support call completion.