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

3016 Participants Needed

Trial Summary

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 data supports the effectiveness of the treatment Nurse Nudge in reducing emergency room visits?

A study in Sweden showed that a telephone-based, nurse-led case management intervention reduced hospital visits by 12% for frequent emergency department users, suggesting that similar nurse follow-up calls could help reduce emergency room visits. ^{1 2 3 4 5}

Is the nurse follow-up call intervention generally safe for humans?

The study on nurse-led case management interventions, which includes follow-up calls, suggests that these interventions are safe and can reduce healthcare use without indicating any safety concerns for participants. ^{5 6 7 8 9}

How does the Nurse Nudge treatment differ from other treatments for reducing emergency room visits?

The Nurse Nudge treatment is unique because it involves follow-up phone calls by nurses after a patient is discharged from the emergency room, aiming to remind patients to schedule follow-up appointments and adhere to discharge instructions. This approach is different from other treatments as it focuses on personalized, post-discharge communication to reduce emergency room revisits, rather than direct medical interventions. ^{1 2 5 10 11}

What is the purpose of this trial?

The project aims to evaluate a nurse-led intervention to reduce inappropriate emergency department (ED) use among adult patients seen at Geisinger's Community Medicine Service Line (CMSL) clinics. The intervention occurs immediately following an appointment where they received a diagnosis of an ambulatory sensitive condition (ASC). The evaluation will compare eligible patients with an ASC who were randomly assigned to receive follow-up outreach from a nurse (who was automatically prompted via the Epic electronic health record system to initiate outreach) with those who were randomly assigned to receive standard care. Analyses will be intent-to-treat. The primary outcome is ED use in the week following the appointment.

Eligibility Criteria

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

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

Treatment Details

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.

Participant Groups

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+

Findings from Research

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 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]

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 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]

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]

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]

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]

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]

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]

References

1. England pubmed.ncbi.nlm.nih.gov

Randomized controlled trial of a nursing intervention to reduce emergency department revisits. [2019]

2. England pubmed.ncbi.nlm.nih.gov

Costs and effects of interventions targeting frequent presenters to the emergency department: a systematic and narrative review. [2020]

3. United States pubmed.ncbi.nlm.nih.gov

ED-based care coordination reduces costs for frequent ED users. [2018]

4. United States pubmed.ncbi.nlm.nih.gov

Reconnecting patients with their primary care provider: an intervention for reducing nonurgent pediatric emergency department visits. [2022]

5. Sweden pubmed.ncbi.nlm.nih.gov

["Active health management" can provide support for vulnerable patients. New model for the prevention of unplanned healthcare]. [2018]

6. Canada pubmed.ncbi.nlm.nih.gov

Barriers to and incentives for safety event reporting in emergency departments. [2022]

7. United States pubmed.ncbi.nlm.nih.gov

Intercepting wrong-patient orders in a computerized provider order entry system. [2021]

8. England 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. [2020]

9. United States pubmed.ncbi.nlm.nih.gov

Patient preference for emergency care: can and should it be changed? [2018]

10. United States pubmed.ncbi.nlm.nih.gov

Nurse-Led Call Back Program to Improve Patient Follow-Up With Providers After Discharge From the Emergency Department. [2021]

11. United States pubmed.ncbi.nlm.nih.gov

Time-Driven Activity-Based Costing of Emergency Department Postdischarge Nurse Calls. [2021]