Researchers have found that restructuring the discharge process of a vascular surgery service decreased escalation to clinical staff from an automated post-discharge phone call and improved early post-discharge visits. Thirty-day readmission rates remained unchanged despite these efforts, however, and was increased for patients requesting escalation.
Cara G. Pozolo, MD, a resident at University of California Davis Medical Center in Sacramento, California, presented these findings at the 2022 Vascular Annual Meeting (VAM) in Boston (June 15–18).
The investigators—led by senior author Matthew Mell, MD—looked at all patients discharged from their vascular surgery service who underwent procedures from April 2021 through October 2021 with pre-discharge process improvement (PI) and compared these with a historical cohort discharged from May 2018 through July 2019.
For both cohorts, Polozo detailed, all patients received an automated phone call from a third-party vendor (CipherHealth, New York), with an option to escalate to a clinical nurse.
The investigators analyzed a total of 469 patients who received an automated call (1.4±1 days) after discharge, with 271 in the control group and 198 in the PI group. Polozo revealed that no significant change in overall 30-day readmission rates was observed (11.8% control vs. 10.6% PI; p=0.7). In addition, she communicated that request for escalation to the clinical nurse was significantly less frequent after intervention (28% control vs. 16.7% PI; p=0.004), and that escalation was associated with increased 30-day readmission (8.6% vs. 20.1%; p=0.001) for all patients. Direct calls were made for patients considered high risk for readmission (2% control vs. 43% PI; p<0.001) regardless of escalation status, the presenter added.
On multivariate analysis, Polozo reported that escalation and direct calls were each independently associated with readmission.
Finally, the presenter detailed that the median interval from discharge to post-discharge visit was markedly improved with PI (24 days [IQR 14–33] compared to 16 days [IQR 11–32]; p=0.007). Compared with control, she added, median days from discharge to visit with escalation was not significantly improved.
“These findings support the benefits of a structured discharge approach for post-discharge transition of care,” she concluded.