I love picking up the phone, calling a patient, and finding out that they are feeling better in the day or two following their emergency department visit. Even when the patient doesn’t always improve as expected, it affords me an opportunity to adjust treatment, if necessary, and perhaps another emergency department visit can be averted.

Almost all patients express gratitude that I have taken time to reach out to them—prior studies indicate it improves patient satisfaction metrics.¹ The only difficulty with doing these follow-up calls is finding time to fit them into our workflow. Sure, we can come into the job 30 minutes earlier to make a few phone calls, but our employers likely won’t be paying for our time.

Fortunately, our nursing staff makes this a routine practice, calling patients the day after their emergency department visit. They check on whether prescriptions have been picked up, if follow-up has been arranged, and if the patients feel better.

A recent study, reviewed in this EMRA+PolicyRx Health Policy Journal Club article, demonstrated physician callbacks might reduce future visits among patients initially discharged from the emergency department. Patients all had private insurance coverage with an integrated delivery system. The content of the callback was designed to promote the health system’s Appointment and Advice Call Center. The call center was designed to direct patients away from future ED visits by utilizing nurses and doctors to provide telemedicine-style consults, scheduling urgent appointments, and messaging primary care physicians. Follow-up calls also directed patients to online resources to obtain medication refills and view lab results.

In an integrated health care system, these activities should easily divert unscheduled acute care from the emergency department to other appropriate venues, ultimately reducing health care costs. However, for patients without a robust primary care infrastructure and for clinicians without similar incentives, the emergency department will likely remain a major access point for care during nights, weekends, or other times when primary care remains unavailable.

Though not addressed by this study, I find it beneficial to call our patients, not for their sake but rather for our own. We will never know if someone returned unexpectedly or if a diagnosis is incorrect unless we follow up. And if we don’t, we might miss out an opportunity to hone our craft. 

Reference

1. Guss DA, Leland H, Castillo EM. The impact of post-discharge patient call back on patient satisfaction in two academic emergency departments. J Emerg Med. 2013;44(1):236-241.