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由护士主导的回访项目,以改善急诊科出院患者对医疗服务提供者的后续跟进情况。

Nurse-Led Call Back Program to Improve Patient Follow-Up With Providers After Discharge From the Emergency Department.

作者信息

Luciani-McGillivray Ines, Cushing Julie, Klug Rebecca, Lee Hang, Cahill Jennifer E

机构信息

Department of Nursing, Massachusetts General Hospital Department of Emergency Medicine, Boston, MA, USA.

Biostatistics Unit, Massachusetts General Hospital, Boston, MA, USA.

出版信息

J Patient Exp. 2020 Dec;7(6):1349-1356. doi: 10.1177/2374373520947925. Epub 2020 Sep 30.

Abstract

Phone calls to patients after discharge from the emergency department (ED) serve as reminders to schedule medical follow-up, support adherence to discharge instructions, and reduce revisits to already-crowded EDs. An existing, nurse-administered, call-back program contacted randomly selected ED patients 24 to 48 hours following discharge. This program did not improve patient follow-up (48.68%) nor reduce the ED revisit rate (6.7% baseline vs 6.0% postimplementation). Plan-Do-Study-Act methodology tested a modification to the existing program consisting of a second, scripted phone call from a trained volunteer at 72 to 96 hours postdischarge. Volunteers utilized a patient list and script, and nurses provided expertise to eliminate identified barriers to follow-up. Follow-up rate and ED revisit were monitored through the electronic medical record. A total of 894 patients participated between October 2017 and June 2018. Follow-up increased from 48.68% to 65.5% ( < .0001) and ED revisit decreased significantly (4.5% vs 8.6%, < .001). This innovative nurse-led, systematic postdischarge call-back program utilizing hospital volunteers increased patient compliance with post-ED medical follow-up while significantly reducing the rate of patient revisit to the ED within 7 days of discharge.

摘要

急诊科(ED)患者出院后进行电话随访,有助于提醒患者安排医疗随访、支持患者遵守出院指导,并减少患者返回已经拥挤不堪的急诊科就诊的次数。现有的一项由护士执行的回访计划,会在患者出院后24至48小时随机联系部分急诊科患者。该计划既没有提高患者的随访率(48.68%),也没有降低急诊科的复诊率(实施前为6.7%,实施后为6.0%)。计划-实施-研究-改进(Plan-Do-Study-Act)方法对现有计划进行了一项改进,即在患者出院后72至96小时,由一名经过培训的志愿者进行第二次有脚本的电话随访。志愿者使用患者名单和脚本,护士提供专业知识以消除已确定的随访障碍。通过电子病历监测随访率和急诊科复诊情况。2017年10月至2018年6月期间,共有894名患者参与。随访率从48.68%提高到65.5%(P<0.0001),急诊科复诊率显著下降(从8.6%降至4.5%,P<0.001)。这项由护士主导的创新性系统出院后回访计划,利用医院志愿者提高了患者对急诊科出院后医疗随访的依从性,同时显著降低了患者在出院后7天内返回急诊科复诊的比率。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7ab2/7786663/fa238ef61300/10.1177_2374373520947925-fig1.jpg

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