LAS VEGAS – A structured follow-up telephone call to heart failure patients made within 48 hours post discharge can reduce 30-day readmissions by fully one-half to two-thirds.
That’s been the experience at Stanford (Calif.) University Medical Center, where the 30-day heart failure readmission rate dropped from 20% in 524 patients at baseline to 10% among 341 patients discharged since the follow-up phone call practice was introduced, clinical nurse specialist Christine Thompson reported at the annual meeting of the Heart Failure Society of America.
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The telephone follow-up call was just one element in a set of interventions developed by a multidisciplinary team.
The telephone call follows a scripted template embedded in the patient’s electronic health record. The template incorporates “smart text” questions that assist in identifying gaps in patient care. For example, when Ms. Thompson or another caller asks, “How have you been feeling since discharge?” it provides an opportunity to review the typical symptoms of heart failure and make sure the patient knows how to recognize them.
Other questions review medications and address the patient’s activity level, adherence to the recommended low-sodium diet, and self-weighing at home with tracking of the results. The interviewer also makes sure the patient knows his or her physician’s name, phone number, the date of the next scheduled appointment, and understands the circumstances when it’s important to call the doctor because the clinical picture is beginning to deteriorate, explained Ms. Thompson, who works in the Stanford heart failure program.
The structured telephone follow-up call was merely one element of a whole set of interventions developed by a multidisciplinary Stanford team in an effort to reduce heart failure readmissions. Other interventions included medication reconciliation, routinely scheduling an early postdischarge clinic visit, and an increased emphasis upon patient education using patient “teach back” techniques to promote mastery of key information.
In the first 14 months since the full readmission-reduction program was launched, 96% of patients reached via a postdischarge phone call demonstrated that they understood their discharge medications and how to take them.
It was possible to determine the specific contribution that the early postdischarge phone call made to the observed sharp decrease in 30-day readmissions because 61 patients didn’t get the follow-up phone call but did receive the other interventions. Their 30-day readmission rate was 28%, compared with 10% in those who did get the phone call, which translates to a 66% relative risk reduction. In a multivariate logistic regression analysis adjusted for the other interventions as well as patient age, sex, marital status, length of stay, and discharge destination, the early postdischarge follow-up phone call was independently associated with a 72% reduction in the risk of readmission within 30 days, according to Ms. Thompson.
She reported having no financial conflicts regarding this study.