The Role of Call-Back Systems in Older Patients Discharged from the Emergency Department
Abstract
Objectives: UC Irvine in partnership with CipherHealth has incorporated an automated call-back system utilizing a Geriatric Emergency Nurse Initiative Expert (GENIE) to follow-up with older patients. This study aimed to discover the most significant concerns older patients have after discharged from the ED, impact of a call-back system, impact of a dedicated GENIE in the follow-up process, and to highlight areas for further research.
Background: Emergency departments (ED) can be challenging to navigate for elderly patients. Geriatric visits to the ED are common and costly for both patients and health systems. Additionally, older patients are more likely to have a longer length of stay, increased complications and worse health outcomes. Over the past decade, there has been increasing efforts to incorporate geriatric specific care in emergency departments. The goal of these programs was to better communicate with older patients regarding their health and reduce recidivism.
Methods: CipherHealth data regarding call-back rates and intervention details for UC Irvine Medical Center and UC Irvine Health were collected from June to November of 2021. Additionally, call-back data from the geriatric specialist nurse was collected during this time period and compared to the call-back rates of the automated CipherHealth system. Using the GENIE call-back data, we grouped call-backs into categories based on specific patient concerns. Finally, recidivism rates were obtained prior to the implementation of CipherHealth and geriatric nurse specialists and compared with those seen after.
Results: There were a total of 4,748 initial calls made with the Cipher Health system and 292 individual follow-up calls made by the GENIE. Of the calls made by the GENIE the most common issue was with follow-up appointments (99 recorded issues). The next most common issue was with discharge instructions (82 recorded issues), followed by general status issues (80 recorded issues), issues obtaining prescriptions (18 recorded issues), and medication questions (13 recorded issues). Additionally, the rate of recidivism for patients over the age of 65 prior to the implementation of the call-back system was 20.9 percent compared with 15.6 percent in the months following implementation of these systems.
Conclusion: Our data suggests that there are specific areas of intervention that many older patients have issues with post-discharge. These concerns centered around follow-up appointments and discharge paperwork, suggesting an avenue for future quality improvement. Additionally, the decrease in recidivism after implementation of the call-back systems are a promising sign. A future study would be needed to prove true causation however there are reasons for optimism.