Impact of Automated Post-Discharge Phone Calls on 30-Day Hospital Readmission Rates

Abstract

Background Reducing 30-day readmissions is a priority among hospitals nationwide as it is tied to reimbursement and used as a surrogate quality indicator. As an all-payor system, Maryland has the added challenge to reduce 30-day readmissions to below the national rate to be in compliance with its contract with the Centers for Medicare and Medicaid Services. Local Problem Readmission rates among trauma patients in a level-1 trauma center of a large, urban academic medical center in Baltimore, MD have been increasing over the first few months of 2018. The purpose of this quality improvement project was to implement and evaluate the effect an automated post-discharge phone call program had on 30-day readmissions and Hospital Consumer Assessment of Healthcare Providers and Systems scores on an acute care trauma unit. Interventions This project implementation took place over nine weeks. The first week was dedicated to staff education. Patients were given verbal as well as written materials regarding the phone call they were going to receive during their discharge education by the nurse. In weeks 29, post-discharge phone calls went out to adult patients being discharged home within 24-72 hours. Three attempts were made to contact the patient, after which a message was left for them to call back. Patients were asked questions about their current health status, follow-up care, medications, instructions, and satisfaction. If they answered negatively, the system would trigger an alert and a registered nurse would follow-up with them the same day. Demographic data including age, gender, primary diagnosis, and mechanism of injury was collected weekly along with survey completion rates, number and type of alerts generated. Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores and 30-day readmission rates were evaluated one month after the last phone call. Results 104 patients were called, 55.7% of patients completed the survey. 44.8% of those who completed triggered an alert. 29% of alerts were related to follow-up care, 23% related to instructions. Mean age was 6.6 years higher for patients who completed the survey compared to those that did not (40.9 vs 34.3). Readmissions decreased by 2.9%. There were no statistically significant associations between completing the survey and readmission rates (p=0.46). Hospital Consumer Assessment of Healthcare Providers and Systems scores increased in two categories: 4.6% in Care Transitions and 9.6% in Good Understanding of Managing Health. There was not a large enough sample size to determine significance. Conclusions Automated post-discharge phone calls have the potential to reduce 30-day readmission and improve patient satisfaction scores. Further analysis of additional data should be completed at six months to test for a significant association between survey completion, readmission rates, and HCAHPS scores. The potential costs of savings of this project was estimated to be $181,500. Future similar quality improvement projects should be aimed at increasing the number of follow-up appointments and improve patient understanding of instructions before discharge home.