Ten Years Later: Are We Still Facilitating a Safe Transition Home for our ED Patients

Session I presented Saturday, September 29, 10:00-11:00 am Purpose: This poster focuses on the benefits of a nurse-facilitated post-discharge follow-up program in an ED and the subsequent evaluation of that program ten years after implementation. A grass roots approach to evidence based practice (EBP), involving direct care nurses and EBP mentors, was conducted to evaluate this program in light of current evidence. As a result, the team was able to validate the current program, make recommendations to develop a hospital-wide program and to add a more robust care coordination approach for discharged patients. Design: This project was initiated to both evaluate and make recommendations for change to our existing program and to provide an opportunity to involve and train direct care nurses in the EBP process. Setting: Level II Trauma Center. Participants/Subjects: Team of six ED nurses who do post-discharge phone calls to patients . Two of these nurses had received additional training in EBP and functioned as mentors. Methods: This ED post discharge follow-up program is now in it's eleventh year. Since this time, we have measured call volume, 48 hour return data and conducted staff and patient satisfaction surveys. These surveys were initially conducted in 2008 and have recently been conducted again. The nurses have had multiple opportunities over the past ten years to disseminate about the program. (JEN article, Magnet convention poster and presentation, various posters presentation including ENA and mentored two other ED in the development of their own program.) The decision was made to re-evaluate our program in light of current evidence and to involve our nurse team in the progress. The team was mentored in the EBP process and over the following months, were able to: - Develop a PICOT question, - Perform a literature search and review fifteen articles, - Complete a critical appraisal of all articles, - consulted clinical experts, - made recommendations to enhance the program. As a result: - new technology is being evaluated to enhance productivity, - decision support tools are being evaluated to ensure continuity of patient care, - tools to enhance ability to make contact with more patients are being explored, - Inpatient nurses are being mentored to develop a hospital-wide post-discharge call program, - Efforts to incorporate more care coordination in post-discharge care are being considered, - Data points are being re-evaluated to assure that they are meaningful. Results/Outcomes: The outcomes measured were: return ED visits, return admissions, patient compliance with follow-up appointments, self-efficacy and medication errors. Results of the data show: 1. Increased patient and staff satisfaction, 2. Decrease in number of hospital readmissions and ED return visits, 3. Increased compliance with follow-up care, 4. Decreased medication errors. Implications: This project validates the need to identify specific high risk patients to call. In addition, it demonstrates that a post-discharge follow-up program can improve patient and staff satisfaction, enhance quality of care, and improve coordination of care by connecting our patients with primary care providers after discharge. Finally, this emphasizes the role of EBP in evaluating an existing program and the benefits of involving direct care nurses in the EBP process.