The Importance of a Post Emergency Department (ED) Visit Callback System in a Pediatric Setting

Background: Pediatric ED visits can be stressful for patients and their caregivers. This high stress environment can lead to questions and clarification needed post-visit. Through our patient experience survey comments, we identified common points of confusion for our patients after an ED visit. These included the ED diagnosis, disease manifestations, at home care, follow up care, and prescriptions. Our survey system types these as negative. We implemented a post-ED visit callback system to resolve these concerns for a focused subset of ED patients who historically provided the most negative comments on our surveys. We hypothesized that a post ED visit callback system for this subset would enhance their ED experience as demonstrated by comment type shift to more positive, decreased comment themes related to post discharge confusion and a decrease in 72-hour ED return rates.

Methods: We developed a post ED visit callback system that focused on patients who were triaged as ESI level 4. Over a 6-week period, patients’ caregivers were called the day after discharge and asked if they had questions regarding their recent ED visit. Caregivers were asked about their child’s current health, and if they had questions related to the ED visit, discharge instructions, follow up care and prescriptions. A maximum of 3 discharge call attempts were made to contact the patient or family. Patients and families with questions were contacted by a licensed healthcare provider within 24 hours with a maximum of 3 attempts. At study conclusion, we analyzed comments received from our patient experience surveys to identify shifts in comment types and themes. We also analyzed ED return rates within 72 hours of discharge.

Results: 2710 calls were made to contact 1618 patients’ caregivers. Follow up was requested by 149 families. Spanish speaking families required a higher percentage of follow up calls (Table 1). Total time required for the study calls was 12,168 minutes (Table 2). There was no significant change in the number of comment types received. Thematic analysis of the patient experience survey comments revealed a reduction in questions and clarification needed regarding the ED visit as related to diagnosis, disease manifestation, at home care, follow up care and prescriptions. There was no significant change in 72-hour ED return rates.

Conclusion: The institution of a post ED visit callback system can effectively reduce patients’ and families’ confusion post ED visit, by providing an opportunity to answer questions and clarify care. Limitations in communication may still exist for Spanish speaking families despite the use of interpreters. A non-automated system is time intensive, and an automated system may be more efficient.