Good morning, this is your follow-up call.

January 2013

This article was contributed by Philllip Beckley, Senior Atrial Fibrillation Clinical Specialist, Society of Cardiovascular Patient Care

How According to the US Department of Education, nearly 90% of adults in this country are less than proficient in reading, understanding, and acting on medical information 1. The report indicates that patients with poor literacy and retention skills tend to have more medication or treatment errors, are less likely to be compliant with instructions, are 50% more likely to be hospitalized, and rack up four times more in annual medical costs than patients with higher proficiencies in literacy and retention.

Best practices demonstrate that interactive discharge instruction methods such as the “teach-back” method are valuable in confirming that the patient understands and is retaining the verbal and written information given to them at discharge 2. Another best practice to ensure that the information has been retained and is being acted on is the follow-up phone call which is made to the patient or caregiver at some interval following the discharge. One hospital in Lancaster, Pennsylvania, found that 60% of their patients had significant questions regarding their medications when called one day following discharge, in spite of the fact that considerable time was spent with the patient in the discharge process 3. One would think that a follow-up phone call with carefully constructed questions to confirm an understanding of the discharge instructions would improve compliance and decrease readmission.

Harrison et al. performed a retrospective study of 30,272 discharged patients to determine if a specialized follow-up call decreased readmission rate 4. The study population comprised patients enrolled in a chronic disease management program and who had a hospital admission for any reason during the 2008 calendar year. The intervention group (n=6773) was made up of all those who received a follow-up phone call within 14 days of discharge and were not readmitted prior to the call. All others formed the comparison group (n=23,499). The primary study measure was a determination of 30-day readmission. It was found that those who received the follow-up phone call were 23.1% less likely to be readmitted within 30 days of discharge (p=0.043). Considering the estimated number of readmissions that would have occurred without the follow-up phone call and the 2008 estimated cost of preventable readmissions, it was determined that nearly $1.4 million was saved by this hospital as a result of the call campaign.

Consideration and adoption of best practices are cornerstones to the Society of Cardiovascular Patient Care' philosophy for process improvement. The Chest Pain Center and Heart Failure Accreditations and Atrial Fibrillation Certification programs each have discharge and transition processes as important building blocks for success. The follow-up phone call is a frequent topic of discussion in the workshops associated with these programs and in the personal attention given to facilities from our Accreditation Review team.

1. Kutner M, Greenberg E, Jin Y, and Paulsen C. The health literacy of America's adults: Results from the 2003 National Assessment of Adult Literacy (NCES 2006-483). Washington, DC: U.S. Department of Education, National Center for Education Statistics, 2006.
2. (accessed 6/27/2012)
3. Aiello M. Treatment guidelines keep readmission rates low. Health Leaders 15(1):49-51, 2012.
4. Harrison P, Hara P, Pope J, Young M, Rula E. The impact of post-discharge telephonic follow-up on hospital readmissions. Population Health Management 14(1):27-32, 2011.