STUDY OBJECTIVE: We evaluate the effect on adverse events of a telephone follow-up quality improvement program. METHODS: This was a before-and-after intervention comparison based on prospectively collected data in a tertiary care hospital emergency department (ED) (82,000 visits per year). The first half (April 15 to July 31, 2001) served as control, and the second half (August 1 to November 15, 2001) served as intervention with feedback to physicians on telephone follow-up outcomes of discharged patients and resident training about the uncertain presentations of serious diseases and the need to use additional evaluation on selected patients (observation unit, hospital admission). Telephone follow-up of the high-risk patients and retrospective review of 3-day return visits were used to quantify outcome measures: return visits to EDs and clinically significant adverse events (return visits with serious misdiagnoses or an erroneous management plan). The differences in proportions of outcomes were measured with 95% confidence intervals (CIs). RESULTS: High-risk patients were enrolled: 566 (13.7%) of 4,139 discharged patients in the before-intervention period and 397 (11.3%) of 3,507 in the after-intervention period. The quality improvement initiative decreased return visits on enrolled patients from 10.1% (57/566) to 4.9% (19/397) (5.2% difference with 95% CI 1.8% to 8.8%) and decreased clinically significant adverse events from 4.1% (23/566) to 1.5% (6/397) (2.6% difference with 95% CI 0.3% to 4.8%). For all ED discharged patients, clinically significant adverse events decreased from 0.9% (39/4,139) to 0.4% (15/3,507) (0.5% difference with 95% CI 0.1% to 0.9%). During the study, the observation rate increased 4.3% (95% CI 2.8% to 5.7%), and the admission rate increased 3.4% (95% CI 2.1% to 4.8%). CONCLUSION: A quality improvement program with feedback to physicians of telephone follow-up and resident education can decrease clinically significant adverse events in ED discharged patients.
STUDY OBJECTIVE: We evaluate the effect on adverse events of a telephone follow-up quality improvement program. METHODS: This was a before-and-after intervention comparison based on prospectively collected data in a tertiary care hospital emergency department (ED) (82,000 visits per year). The first half (April 15 to July 31, 2001) served as control, and the second half (August 1 to November 15, 2001) served as intervention with feedback to physicians on telephone follow-up outcomes of discharged patients and resident training about the uncertain presentations of serious diseases and the need to use additional evaluation on selected patients (observation unit, hospital admission). Telephone follow-up of the high-risk patients and retrospective review of 3-day return visits were used to quantify outcome measures: return visits to EDs and clinically significant adverse events (return visits with serious misdiagnoses or an erroneous management plan). The differences in proportions of outcomes were measured with 95% confidence intervals (CIs). RESULTS: High-risk patients were enrolled: 566 (13.7%) of 4,139 discharged patients in the before-intervention period and 397 (11.3%) of 3,507 in the after-intervention period. The quality improvement initiative decreased return visits on enrolled patients from 10.1% (57/566) to 4.9% (19/397) (5.2% difference with 95% CI 1.8% to 8.8%) and decreased clinically significant adverse events from 4.1% (23/566) to 1.5% (6/397) (2.6% difference with 95% CI 0.3% to 4.8%). For all ED discharged patients, clinically significant adverse events decreased from 0.9% (39/4,139) to 0.4% (15/3,507) (0.5% difference with 95% CI 0.1% to 0.9%). During the study, the observation rate increased 4.3% (95% CI 2.8% to 5.7%), and the admission rate increased 3.4% (95% CI 2.1% to 4.8%). CONCLUSION: A quality improvement program with feedback to physicians of telephone follow-up and resident education can decrease clinically significant adverse events in ED discharged patients.
Authors: Eta S Berner; Midge N Ray; Anantachai Panjamapirom; Richard S Maisiak; James H Willig; Thomas M English; Marc Krawitz; Christa R Nevin; Shannon Houser; Mark P Cohen; Gordon D Schiff Journal: J Gen Intern Med Date: 2014-03-08 Impact factor: 5.128
Authors: Christina L Cifra; Cody R Tigges; Sarah L Miller; Nathaniel Curl; Christopher D Monson; Kimberly C Dukes; Heather S Reisinger; Priyadarshini R Pennathur; Dean F Sittig; Hardeep Singh Journal: Appl Clin Inform Date: 2022-05-11 Impact factor: 2.762
Authors: Lisa Calder; Anita Pozgay; Shena Riff; David Rothwell; Erik Youngson; Naghmeh Mojaverian; Adam Cwinn; Alan Forster Journal: BMJ Qual Saf Date: 2014-12-24 Impact factor: 7.035
Authors: Alexandra T Strauss; Cameron Morgan; Christopher El Khuri; Becky Slogeris; Aria G Smith; Eili Klein; Matt Toerper; Anthony DeAngelo; Arnaud Debraine; Susan Peterson; Ayse P Gurses; Scott Levin; Jeremiah Hinson Journal: JMIR Hum Factors Date: 2022-03-23