What is the effect of telephone aftercare for elderly patients, who are discharged home from the Emergency Department of a large inner-city hospital?

Elderly patients, discharged to a home setting from the Emergency Department (ED) may be at high risk for adverse outcomes. To improve their outcome, telephone aftercare was started in our hospital. We would like to assess whether telephone aftercare for patients of ≥70 years after ED discharge to a home setting leads to reduction in hospital admissions and return ED visits within 30 days, better patient satisfaction and cost-effectiveness. We will conduct a comparative study with two groups: an intervention group, who will receive a telephone call from a specialized ED nurse during which discharge instructions are reviewed, follow-up appointments and care are facilitated and patient satisfaction will be scored, and a control group who will receive a patient satisfaction survey telephone call. After 30 days health service use of all patients will be evaluated.

We hypothesize that telephone aftercare for patients of 70 years and older within 24 hours after discharge to a home setting from the ED will lead to a reduction in hospital admission, in avoidable, unanticipated hospital admissions and ED visits within 30 days after the ED visit; that it will improve patient satisfaction; and that it will be cost-effective. We hypothesize that for patients with cognitive impairment and hazardous alcohol use telephone aftercare will not be as effective, whereas decreased general daily functioning and crowding in the ED during discharge of the patient will predict a positive effect of telephone aftercare.

30 days after ED discharge

Patients in the intervention group will receive a telephone call from a specialized ED nurse within 24 hours after ED discharge during which discharge instructions are reviewed and follow-up appointments and care are facilitated if needed. Patients will also be asked to give a satisfaction score for the treatment they received in the ED. Patients in the control group will receive a patient satisfaction survey telephone call within 24 hours after ED discharge.