Healthcare organizations can no longer afford to send patients home, then simply close the file on their care. Instead, a more proactive and timely approach to patient follow-up is being driven by healthcare's focus on improving safety and reducing risk. The importance of follow-up is further buoyed by the growing emphasis on patient satisfaction scores and their link with reimbursement.
Think for a moment about traditional patient follow-up strategies, which typically include satisfaction surveys mailed to patients after discharge. While certainly helpful, this kind of follow-up offers little more than a stagnant, vague recollection of the encounter--usually weeks after the fact. It is primarily retrospective in nature; few proactive measures can be taken as a result. Furthermore, given the small sample size of many satisfaction surveys, their utility often is limited to Centers for Medicare & Medicaid reporting or to the quarterly benchmarking of a department as a whole against competitors.
By contrast, taking steps to contact patients immediately after discharge can give healthcare organizations valuable real-time opportunities to improve patient care, reduce readmissions and understand important patient perceptions. Rather than viewing a "still image" of the care experience, organizations need to capture "moving video" feedback that more accurately reflects the post-discharge clinical situation for as many individual patients as possible, and assures they are maintaining an appropriate trajectory toward maximum recovery.
Tailor Follow-up for Maximum Impact
For follow-up to be effective, it must address the reason why a patient presented, as well as what occurred during the encounter. It is especially important any time a patient presents for a procedure or is advised to change his or her medical care plan.
Take, for example, a patient who is prescribed a new medication. Contacting that patient shortly after the visit allows providers to ensure the prescription is filled, clarify questions about the dosage or potential drug interactions, and safeguard against possible side effects.
Even when there is no change in the care plan, immediate follow-up with patients offers better insight into their perceptions about the service rendered. For instance, although an emergency department visit for a simple laceration seldom has any long-term care implications, healthcare organizations still can monitor the quality of staff service with questions such as, "Did staff see you in a timely manner?" or "Was the room tidy upon your arrival?"
Benefits for Patients and Staff
Patient feedback can be a powerful tool to drive improvement, as evidenced by a recent case study involving patients discharged from the emergency department (ED) of Edward Hospital in Naperville, Illinois. In this case, patients were asked whether they preferred to be contacted for follow-up via email, text message or by telephone the day after discharge. All were asked to respond to five self-assessment questions designed to assess well-being and satisfaction.
Of those patients who responded electronically to the outreach, roughly 95 percent said their conditions were unchanged or improving, with no barriers to aftercare. Two percent reported feeling worse, and as a result a charge nurse was notified to address the clinical concerns. Another 4 percent reported aftercare problems, and were promptly sent to a case manager for resolution. (Note that 1 percent overlapped with both a worsening condition and aftercare issues.) Such early interventions likely helped control unnecessary return ED visits and improved outcomes.
In addition, 6 percent of the patients who responded were routed to an ED administrator because of a service issue, compliance or other non-clinical concern. Addressing patient problems quickly helps staff reduce gaps between patients' perceptions of care quality and true care quality. At Edward Hospital, the timely follow-up provided an opportunity to correct misperceptions and de-escalate dissatisfied patients, which might serve to reduce the costs and hassles associated with non-meritorious claim litigation.
In most cases, however, feedback provides as much positive reinforcement as negative—thereby arming hospital leaders with the kudos and compliments needed to recognize and inspire staff. For example, during Emergency Nurses Week at Edward Hospital, hundreds of positive emails were condensed into a single motivational communication to the ED team to acknowledge patients' appreciation for the great job the staff is doing.
Evaluate Follow-up Methods
Many vehicles are available for patient follow-up, each with its own merits and drawbacks. Healthcare organizations should take into account the following points to help determine which follow-up mechanism is best for their patient populations:
- Mailed materials: Mailed surveys usually are viewed as non-intrusive because they give patients time to read and respond thoughtfully on their own schedules. Yet because they typically return to a hospital weeks after an encounter, they are not timely enough to be used to check on patients' well-being. Patients also may have forgotten details of the experience by the time they get around to completing the survey. In addition, although helpful for capturing service perceptions, service issues may escalate before a survey is returned. At an estimated cost of more than $10 per completed survey, mailings are expensive--especially when considering that they generally generate a feedback rate of only 1 or 2 percent of patients, which offers inadequate statistical validity for measuring provider performance. (Because paper surveys are often quite lengthy, patients are less inclined to fill them out.)
- Telephone callbacks: Timelier than mail, telephone calls are very valuable for well-being checks. The human touch is less sterile than electronic mechanisms and can reflect an organization's caring personality. Although phone calls may be preferred by non-tech savvy patient populations, calls also have the potential to be seen as disruptive. They seldom allow time for thoughtful response on the patient's own schedule. Moreover, making phone calls manually requires additional staff, which is expensive. In the experience at Edward Hospital, about 20 calls must be placed in one hour in order to reach six patients with a short, five-question survey.
- Interactive Voice Response system: These so-called "robo-calls" can be a very efficient and cost-effective way to deliver a single message, such as an appointment reminder or an announcement about flu shot hours. However, as with live call-backs, they can be disruptive--even offensive to patients who dislike automated calls--particularly when those calls require spoken or dial-pad-entered responses.
- Electronic communication via email or text message:By enabling immediate feedback and escalation to a care team, these technologies are very effective for checking on patients' health status. They are non-disruptive and give patients control over when to respond, while also being easily tracked and highly actionable. Because this automated process doesn't require additional nursing staff, it significantly lowers costs per patient contact. Yet while often preferred by tech-savvy patient populations, electronic messages do have the potential to be viewed as impersonal.
- Hybrid system: This approach provides a combination of electronic and live provider contact for those who desire an in-person conversation. Advanced systems allow operators to contact patients who do not reply electronically within a prescribed period of time. Thus, hybrid systems can lower costs while achieving contact rates of above 60 percent and providing a more personal follow-up option.
Best Practice: Just Do It
Patient follow-up will play a significant role for hospitals striving to meet new requirements to monitor care and measure patient satisfaction. As organizations continue to define care as a "continuum" rather than discreet episodes, the question is not whether an organization should conduct patient outreach, but rather how it should be accomplished. Automated patient contact offers an effective option to help improve care, patient satisfaction and staff performance. Regardless of the method chosen, though, the best practice is to conduct some form of timely patient follow-up after every patient encounter.