Post-Visit Follow-Up Call: A Quality Improvement Project to Decrease Return Visits and Improve Outcomes in an Acute Care Oncology Clinic

Background: Failure to effectively communicate at discharge can lead to ineffective care transitions, adverse events and repeat visits. Potentially avoidable visits contribute to rising costs and poor patient experience. Follow-up calls to patients transitioning from an inpatient hospitalization to home is a well-documented intervention in the literature. There is a lack of data exploring the transition from the outpatient environment to home and, therefore, warrants more exploration. Purpose: This quality improvement intervention aimed to assess the impact of a follow-up phone call made to patients transitioning from an outpatient oncology urgent care clinic to home. The primary goal was to determine whether this care intervention decreased return visits. Methods: This project setting was an acute care oncology clinic within a nationally designated cancer center. Prior to the intervention, a baseline assessment was made of current provider discharge practices. The intervention consisted of RN initiated phone call to administer the Care Transition Measure (CTM) questionnaire to patients 24 hours after discharging from the clinic. The CTM was administered to 186 patients over a 2-month period, and pre- and post-intervention return visit rate was compared for measurable decrease. Results: 186 participants completed the CTM questionnaire. Although there was no measurable change in pre- and post-intervention return rate (p>0.316), areas for improvement in the discharge process were identified. Some of the key elements identified were the ability to intervene sooner with patients experiencing escalating symptoms and clarifying misunderstandings related to discharge instructions and medication management Conclusions: A follow-up call is an easily initiated intervention that can improve overall patient care and experience. Our intervention provides preliminary evidence that the need for telephone follow-up after outpatient clinic discharge needs to be further explored. Our pilot intervention warrants continuation of post-visit follow-up calls within our clinic. It is clear that larger patient enrollment is needed to justify dissemination to other outpatient clinics within our hospital system.