Nurse Follow-Up Calls for Reducing Emergency Room Visits

Overseen By Amir Goren, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Geisinger Clinic

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 1

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests whether follow-up calls from nurses, known as "Nurse Nudge," can reduce unnecessary emergency room visits. It targets patients visiting Geisinger's clinics who receive a diagnosis that might not require emergency care, known as an ambulatory sensitive condition. Participants will either receive a call from a nurse for additional support or continue with regular care. This trial suits adults diagnosed with a condition that could potentially be managed outside of emergency services. As an unphased trial, it allows patients to contribute to innovative healthcare solutions that could enhance care management.

Do I need to stop taking my current medications for this trial?

The trial information does not specify whether you need to stop taking your current medications.

What prior data suggests that this nurse-led intervention is safe?

Research has shown that follow-up calls led by nurses are generally safe. Studies on similar programs suggest these calls can reduce unnecessary doctor visits without causing harm. In this program, nurses call patients after their appointments to help them better follow medical advice.

These follow-up calls are common in many healthcare systems. They help ensure patients understand their care needs, which can prevent unnecessary emergency room visits. Overall, patients respond well to this approach, and it has not been linked to any serious safety issues. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the Nurse Nudge protocol because it offers a proactive approach to reducing emergency room visits. Unlike standard care, which may involve inconsistent follow-up, Nurse Nudge ensures that nurses receive specific notifications to reach out to patients after certain diagnoses. This targeted follow-up could lead to better patient outcomes by addressing issues early, potentially decreasing the need for emergency care. By streamlining communication and ensuring timely nurse intervention, Nurse Nudge could transform how outpatient care is managed.

What evidence suggests that the Nurse Nudge intervention is effective for reducing emergency room visits?

Research has shown that nurse-led programs can greatly reduce emergency room visits. For instance, a program where nurses managed patient care lowered hospital visits by 12% for frequent emergency room visitors. Another review found that these programs not only reduced emergency visits but also improved social outcomes for frequent visitors. Additionally, such programs have led to a 14% drop in emergency room visits per 1,000 patients. In this trial, participants in the "Nurse Nudge" arm will receive follow-up calls from nurses after a clinic visit, potentially reducing unnecessary trips to the emergency room. ^{2 6 7 8 9}

Are You a Good Fit for This Trial?

This trial is for adult patients at Geisinger's CMSL clinics who have been diagnosed with conditions that don't usually require emergency department care. They must have just had an appointment where they received this diagnosis.

Inclusion Criteria

I have been diagnosed with a condition that can be managed without hospital admission.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

Intervention

Nurses provide follow-up outreach to patients after receiving an ambulatory sensitive diagnosis

1 week

1 follow-up call

Follow-up

Participants are monitored for emergency department visits and nurse call frequency

1 week

What Are the Treatments Tested in This Trial?

Interventions

• Nurse Nudge

Trial Overview The study tests if a 'nurse nudge'—a follow-up outreach by a nurse prompted via the health record system—can reduce unnecessary emergency visits compared to standard care after diagnosing ambulatory sensitive conditions.

How Is the Trial Designed?

Group I: Nurse Nudge Experimental Treatment 1 Intervention

Nurses in CMSL clinics will receive a notification to provide follow-up outreach to patients after the patient receives an ambulatory sensitive diagnosis.

Group II: Control Active Control 1 Intervention

Nurses in CMSL clinics will receive standard follow-up notifications, which may mean no notifications, after a patient has received an ambulatory sensitive diagnosis.

Who Is Running the Clinical Trial?

Geisinger Clinic

Lead Sponsor

Trials

159

Recruited

1,976,000+

Published Research Related to This Trial

A pilot intervention involving community health workers and an interdisciplinary clinical team led to a 35% reduction in emergency department visits and a 31% reduction in hospital admissions among frequent ED users, suggesting improved care coordination.

Patients in the intervention group experienced lower average direct costs for both emergency department and inpatient care, indicating that such programs can not only enhance patient care but also reduce healthcare costs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

ED-based care coordination reduces costs for frequent ED users. Lin, MP., Blanchfield, BB., Kakoza, RM., et al.[2018]

A structured intervention aimed at educating families on how to seek medical advice effectively reduced nonurgent visits to pediatric emergency departments (PED) by 11% over a 12-month period, with 43% of the intervention group using the PED compared to 54% in the control group.

The intervention also led to an increase in sick visits to primary care providers (PCP) among the intervention group, indicating a successful redirection of care from the PED to appropriate primary care services.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Reconnecting patients with their primary care provider: an intervention for reducing nonurgent pediatric emergency department visits. Sturm, JJ., Hirsh, D., Weselman, B., et al.[2022]

A telephone-based, nurse-led case management intervention for frequent emergency department visitors significantly reduced hospitalization rates by 12% over two years, particularly in the last year of the study involving 12,181 participants.

The study highlights that the effectiveness of such interventions can vary based on the delivery model used, emphasizing the importance of careful design and staff training in achieving positive outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

["Active health management" can provide support for vulnerable patients. New model for the prevention of unplanned healthcare]. Edgren, G., Anderson, J., Dolk, A., et al.[2018]

A nursing intervention at emergency department discharge, which included a meeting and follow-up calls, did not significantly reduce the rate of ED revisits within 30, 90, 180, or 365 days for patients at risk of revisiting the ED.

However, the intervention group did experience a significantly lower rate of hospitalizations at 180 days compared to the control group, suggesting some benefit in reducing hospital admissions despite no impact on ED revisits.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Randomized controlled trial of a nursing intervention to reduce emergency department revisits. Cossette, S., Vadeboncoeur, A., Frasure-Smith, N., et al.[2019]

A modified post-discharge call-back program, involving a second call from trained volunteers, significantly improved patient follow-up rates from 48.68% to 65.5% among 894 patients studied between October 2017 and June 2018.

The same program also led to a significant reduction in emergency department revisits, decreasing from 8.6% to 4.5%, demonstrating its effectiveness in enhancing patient compliance and reducing strain on emergency services.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Nurse-Led Call Back Program to Improve Patient Follow-Up With Providers After Discharge From the Emergency Department. Luciani-McGillivray, I., Cushing, J., Klug, R., et al.[2021]

A study involving 106 interviews with nursing staff from 94 emergency departments in British Columbia identified six main barriers to reporting patient safety events (PSEs), including time constraints and fear of reprisal, which contribute to the low reporting rates of only 4-50%.

Incentives for reporting PSEs were also identified, such as valuing the reporting process and providing feedback on changes made as a result of reports, which could help improve the overall safety culture in healthcare settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Barriers to and incentives for safety event reporting in emergency departments. Brubacher, JR., Hunte, GS., Hamilton, L., et al.[2022]

A statewide survey found that 69.3% of patients visit the emergency department (ED) for conditions they perceive as urgent, but the time taken to seek care varies widely, with some patients waiting over a week despite their urgency perception.

The study indicates that healthier individuals tend to seek ED care more quickly than sicker patients, and while 80.4% would return to the same ED for a similar issue, this willingness decreases significantly with longer waiting times, suggesting potential areas for improving patient flow and care strategies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Patient preference for emergency care: can and should it be changed? DeLia, D., Cantor, JC., Brownlee, S., et al.[2018]

Postdischarge telephone calls by nurses significantly reduce patient return rates to healthcare systems, with a return rate of 3.5% for patients reached versus 6.3% for those not reached, indicating a strong efficacy in preventing unnecessary hospital visits.

The cost of implementing these call programs is relatively low at $4.69 per patient reached, leading to a cost-saving of $134.89 for each return to the hospital that is prevented, highlighting their cost-effectiveness in improving patient outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Time-Driven Activity-Based Costing of Emergency Department Postdischarge Nurse Calls. Liu, Y., Luciani-Mcgillivray, I., Hughes, M., et al.[2021]

The implementation of a computerized patient verification system in five emergency departments led to a 30% immediate reduction in wrong-patient orders, which was sustained at a 24.8% reduction after two years.

The intervention required providers to confirm patient identity with a brief dialog, which, despite taking an average of 4.2 seconds, significantly contributed to preventing errors during order entry, highlighting the importance of such systems in improving patient safety.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Intercepting wrong-patient orders in a computerized provider order entry system. Green, RA., Hripcsak, G., Salmasian, H., et al.[2021]

A systematic review of 16 studies on interventions for frequent Emergency Department (ED) presenters found that most case management approaches led to a reduction in both ED usage and associated costs.

Despite the positive outcomes regarding cost reduction, there were no studies assessing the cost-effectiveness of these interventions, indicating a need for further research in this area.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Costs and effects of interventions targeting frequent presenters to the emergency department: a systematic and narrative review. Korczak, V., Shanthosh, J., Jan, S., et al.[2020]

Participants in the study overestimated the severity of certain symptoms, leading to inappropriate visits to emergency departments, which adds strain to healthcare systems.

When informed of the actual severity of their symptoms, only about half of the participants changed their choice of health service, indicating that while health education can help, it may not fully resolve the issue of misperception regarding symptom severity.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Overestimation of health urgency as a cause for emergency services inappropriate use: Insights from an exploratory economics experiment in Portugal. Botelho, A., Dias, IC., Fernandes, T., et al.[2020]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10768496/

Impact of an emergency department nursing intervention ... The emergency department nursing interventions significantly improved the continuity of care, enhanced patients' self-care abilities, and reduced psychological ...

2. withpower.com withpower.com/trial/phase-emergencies-2025-63d8e

Nurse Follow-Up Calls for Reducing Emergency Room Visits A telephone-based, nurse-led case management intervention for frequent emergency department visitors significantly reduced hospitalization rates by 12% over two ...

3. sciencedirect.com sciencedirect.com/science/article/abs/pii/S019606441630083X

The Effectiveness of Emergency Department Visit ... We evaluated the quality of 38 studies and found 13 to be of moderate or high quality. Within these 13 studies, only case management consistently reduced ED use ...

4. onlinelibrary.wiley.com onlinelibrary.wiley.com/doi/10.1111/acem.13060

Effectiveness of Interventions to Decrease Emergency ... This systematic review shows that interventions targeting frequent ED users are likely to effectively decrease ED visits and improve social outcomes, such as ...

5. jmir.org jmir.org/2019/10/e14772/

Reduced Hospitalizations, Emergency Room Visits, and ... Results: Hospitalizations and emergency room visits per 1000 decreased 32% (26.5/82.4) and 14% (31.3/219.9), respectively, after we implemented ...

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC7786663/

Nurse-Led Call Back Program to Improve Patient Follow ... This innovative nurse-led, systematic postdischarge call-back program utilizing hospital volunteers increased patient compliance with post-ED medical follow-up.

7. cleartriage.com cleartriage.com/wp-content/uploads/Decreasing-ER-Utilization-with-Nurse-Telephone-Triage.pdf

Decreasing ER Utilization with Nurse Telephone Triage Today, all managed care organizations utilize nurse telephone triage call centers for their members to help decrease unnecessary emergency room visits.

8. cipherhealth.com cipherhealth.com/blog/reducing-emergency-department-recidivism-risk-with-automated-post-visit-calls/

Reducing Emergency Department Recidivism Risk with ... The objective of this study is to assess the impact of post-visit automated calls in reducing the risk of avoidable ED revisits.

9. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10986286/

Medical advice lines offering on-demand access to ... This study investigates the effect of offering patients the option to instantly connect with emergency care providers instead of being referred to the ...