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Postoperative Issues/Are there criteria-based discharge phone calls?

QUESTION:

Do any ambulatory surgery sites have criteria-based discharge phone call processes? We are currently attempting contact with 100%, reaching only 60% of patients.

-- From Christine Barrett

REPLY:

The scope of ambulatory surgery is evolving. Newer minimally invasive techniques continue to allow us to perform procedures in lesser intensity facilities with faster recovery. We need information on our patient’s well being quickly so that we can assess our programs and make continual improvements. Additionally our patients will appreciate the caring reassurance that a timely follow-up provides.

We should make every effort to call our patients post-operatively quickly. Given these great goals, getting call backs done successfully is a fine art.

I surveyed several of our units including outpatients processed in our large hospital based surgery units as well as two free standing surgery centers. Additionally we asked about a system that requires contacting patients for expedited appointments.

The hospital based unit performed at about the 50-60% rate. What we found was that they were using intake forms that did not have space for updating contact information. Subsequent calls were made using phone numbers stored in the main admitting system. We are modifying this approach but due to the lag time to change forms I don’t expect immediate improvement.

An additional problem that we encounter is not contacting the patient directly or with answering machines. Many patients having cosmetic procedures want this information guarded closely. This preference in combination with HIPPA guidelines have limited our aggressiveness of tracking down individuals.

Happily, our free standing surgery centers have had excellent (95+ %) success. Both centers ask for a contact number (cell, home, hotel, etc.) when they are giving discharge instructions. They inform the patients and their responsible adult that they will be called the next day. One of the nurses compares the discharge sheets to the surgical schedule to ensure that no one is missed. Also if they cannot contact the patient on day one they try again the following day.

One of our departments has a system for rapidly returning results for expedited appointments. When the patient cannot receive an appointment directly on the first phone contact, they are guaranteed a phone call within 24 hours. Patients have been very happy and with their motivation to get an appointment, usually give good contact options.

We have also used standardized scripts when we interview patients. By planting an encouraging word during our evaluation, we have seen definite improvements in our patient satisfaction results.

We need to continue to define our patients concerns, be they nausea and vomiting, pain, or scheduling problems to name a few. The only way we can make improvements is to find out this information. Based on our experience, finding an honest contact number prior to discharge is the most likely to yield results.

-- From Robert Helfand, M.D., Cleveland, OH

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