Enhancing the Discharge Process at a Community Hospital With Post Discharge Phone Calls

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MR Cooper, Jefferson College of Population Health Thomas Jefferson University


The purpose of the project is to enhance the patient’s knowledge during the transition period from hospital to home. This transition period has proven to be a heightened time for adverse health events and unnecessary utilization of healthcare services. In an effort to mitigate the danger in the transition period, post discharge phone calls were conducted for a three month period. The target population being patients discharged to home from a medical telemetry unit. The scripted phone calls were made by a registered nurse within 72 hours of the patient’s discharge to home. The patients were asked a series of questions aimed at reinforcing key knowledge regarding their health. The phone calls successfully reached 74% of the target population. Largely, patient’s response indicate the in-hospital discharge process have them prepared to transition to home. Still, the conversations resulted in a number of immediate interventions taking place (arranging for home health, medication consultation, re-providing discharge instructions, etc.). The measurement tool selected was the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey which has a section of questions (“Discharge Domain”) querying patients on discharge information. Prior to the project, the subject nursing unit performed below the national average in the Discharge Domain. We had hoped to move this domain into the top decile of national performance. Unfortunately, there was no evidence the post discharge phones calls impacted the discharge domain. Percentile ranking on the subject unit remained unchanged from prior periods. There is evidence that other domains on the HCAHPS survey were positively influence: Overall Rating, Communication with Nurses and Communication about Medication. All of these domains realized significant increases in percentile ranking over previous experience. We have concluded that the post discharge phone calls are positively impacting patients during the transition period and have extended the trial period.

Presentation: 34:17

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