Follow-Up Scheduling for ER Patients

Overseen By Amir Goren, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Geisinger Clinic

Disqualifiers: Scheduled appointment, Institutionalized, Unreachable, Admitted, others

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

Compensation: Varies

Number of Visits: 1

7500 Participants Needed

Trial Summary

What is the purpose of this trial?

The goal of this campaign is to reduce unnecessary emergency department (ED) visits by encouraging patients with high acuity visits to follow up with an appropriate primary care provider (PCP) or specialist and therefore obtain appropriate care outside of the ED. In this campaign, patients will be assigned to receive or not receive outreach following ED discharge that is aligned with the goal. Outreach will occur via a text message and information added to the patient's after visit summary, and will include a contact number to schedule and hyperlink to allow self-scheduling. The study will assess whether ED use differs across patients in different outreach conditions. It will also examine whether patients followed through on the calls to action in the messages differently across conditions.

Will I have to stop taking my current medications?

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

What data supports the effectiveness of the treatment for scheduling follow-up appointments for ER patients?

Research shows that scheduling follow-up appointments at the time of ER discharge or shortly after can significantly reduce the number of repeat ER visits. This approach improves patient compliance with follow-up care and increases patient satisfaction. ^{1 2 3 4 5}

Is follow-up scheduling for ER patients safe?

The studies reviewed focus on improving follow-up appointment attendance after emergency department visits, but they do not provide specific safety data related to the follow-up scheduling process itself. However, improving follow-up compliance is generally seen as beneficial for patient outcomes. ^{3 6 7 8 9}

How does the follow-up scheduling treatment for ER patients differ from other treatments?

This treatment is unique because it involves scheduling follow-up appointments for ER patients before they leave the hospital, which helps ensure they receive necessary care and reduces the chance of them returning to the ER. Unlike other methods where patients are asked to schedule their own follow-ups, this approach provides a more structured and supportive system, including reminders and assistance with logistics like transportation. ^{1 3 8 10 11}

Research Team

Amir Goren, PhD

Principal Investigator

Geisinger Clinic

Eligibility Criteria

This trial is for patients who have had a high-acuity visit to the emergency department (ED). It's designed to see if follow-up reminders can help them get appropriate care outside of the ED. To participate, individuals must be able to receive text messages and use hyperlinks.

Inclusion Criteria

Attributed to a Geisinger PCP in Community Medicine Service Line

Discharged from ED in past 24 hours

My last ER visit was for a very urgent issue.

Exclusion Criteria

I have a follow-up appointment within a week after leaving the hospital.

Institutionalized

Cannot be contacted via the communication modality being used in the study (i.e., SMS), due to insufficient/missing contact information in the electronic health record or because the patient opted out

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Intervention

Participants receive outreach via text message and information in their after visit summary to schedule a follow-up appointment

1-8 days

1-2 messages sent post-ED discharge

Follow-up

Participants are monitored for ED visits and follow-up appointment attendance

120 days

Treatment Details

Interventions

• Information about scheduling a follow-up appointment

Trial Overview The study tests whether sending a text message with information on scheduling a follow-up appointment with primary care or specialists after an ED visit reduces unnecessary future ED visits. Some will receive this outreach; others won't, to compare outcomes.

Participant Groups

Group I: Experimental: Schedule Follow-Up Visit - 2 messages Experimental Treatment 1 Intervention

This arm will receive text messages (at 1 day and 8 days post-ED discharge) and information added to the patient's after visit summary providing a number and patient portal hyperlink via which to schedule an ED follow-up appointment.

Group II: Experimental: Schedule Follow-Up Visit - 1 message Experimental Treatment 1 Intervention

This arm will receive a text message (at 1 day post-ED discharge) and information added to the patient's after visit summary providing a number and patient portal hyperlink via which to schedule an ED follow-up appointment.

Group III: Control Active Control 1 Intervention

This arm will receive no intervention outside of usual care.

Who Is Running the Clinical Trial?

Geisinger Clinic

Lead Sponsor

Trials

159

Recruited

1,976,000+

Findings from Research

A multicentric follow-up study showed that contacting outpatients after an emergency department visit is feasible, with high success rates of 78.6% to 85.6% regardless of whether the follow-up occurred at 1, 2, or 4 weeks after the visit.

The study found that about 50% of patients could be reached on the first call, indicating that timely follow-up is possible and may help ensure that outpatient services meet patient needs effectively.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Outpatient care in emergency departments: feasibility and comparison of three strategies for follow-up. Houzard, S., Pateron, D., Bleichner, G., et al.[2018]

Implementing a patient-centered follow-up plan, where patients had their outpatient appointments scheduled at the time of emergency department discharge, significantly reduced the rate of return visits to the ED.

The project involved patients with low-acuity complaints and demonstrated that proactive scheduling or follow-up calls within 2 days can effectively improve outpatient follow-up and decrease unnecessary ED revisits.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Improving Outpatient Follow-Up Through Innovative Appointment Scheduling at Emergency Department Discharge. Tessitore, A., Brennan-Cook, J.[2021]

Implementing an appointment assignment system in emergency departments significantly improved patient follow-up compliance and reduced the rate of unscheduled return visits to the ED.

This patient-centered approach not only enhances access to care but also strengthens the overall continuum of care, leading to better quality and increased patient satisfaction.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Facilitating follow-up after emergency care using an appointment assignment system. Vinson, DR., Patel, PB.[2019]

An automated self-scheduling phone system significantly improved follow-up appointment adherence for patients discharged from the emergency department, with 49.3% of those using the system keeping their appointments compared to only 23.4% in the control group.

Despite the increase in follow-up adherence, the automated reminders did not lead to a reduction in return visits to the emergency department within 120 days post-discharge.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Improving Follow-up Attendance for Discharged Emergency Care Patients Using Automated Phone System to Self-schedule: A Randomized Controlled Trial. Bauer, KL., Sogade, OO., Gage, BF., et al.[2022]

A telephone follow-up system in the emergency department successfully reached 81% of patients, helping to clarify discharge instructions and address any concerns, which is crucial for improving patient compliance and satisfaction.

The follow-up calls led to direct medical interventions for most patients who reported worsening conditions, highlighting the system's effectiveness in enhancing patient care post-discharge.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Efficacy of a telephone follow-up system in the emergency department. Jones, J., Clark, W., Bradford, J., et al.[2019]

In a study of 311 patients returning to the emergency department within a week, 79.6% returned due to issues related to their initial visit, indicating a significant rate of unresolved problems.

The evaluation revealed that 21.2% of these return visits had consequences for patients, with 30.5% of those cases deemed avoidable, highlighting areas for improvement in emergency care and patient safety.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Adverse events in emergency departments. Review of reconsultations as a data source]. Martínez, JA., Linares, ML., Soler, MA., et al.[2010]

An automated text message reminder system significantly improved attendance at follow-up appointments after emergency department discharge, with a per-protocol adherence rate of 72.6% compared to 62.1% in the control group.

This intervention was particularly beneficial for patients with lower baseline follow-up rates, suggesting that text reminders could be a cost-effective and scalable solution to enhance patient engagement in their healthcare.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Improving attendance at post-emergency department follow-up via automated text message appointment reminders: a randomized controlled trial. Arora, S., Burner, E., Terp, S., et al.[2022]

Providing follow-up appointments (FA) directly in the pediatric emergency department significantly improved compliance, with 47% of patients in the appointment group and 52% in the intense group attending their follow-ups, compared to only 24% in the control group.

Successful telephone reminders further increased compliance to 62%, highlighting the importance of direct assistance in appointment-making, but the study found no long-term changes in appointment behavior or emergency department usage after the intervention.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A comparison of interventions to improve clinic follow-up compliance after a pediatric emergency department visit. Komoroski, EM., Graham, CJ., Kirby, RS.[2019]

Patients who visit emergency departments during times of long waiting periods face a higher risk of adverse events, such as hospital admission or death, particularly if they are high acuity patients.

However, patients who leave the emergency department without being seen do not show an increased risk of short-term adverse events, suggesting that their decision to leave may not be harmful.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Association between waiting times and short term mortality and hospital admission after departure from emergency department: population based cohort study from Ontario, Canada. Guttmann, A., Schull, MJ., Vermeulen, MJ., et al.[2022]

Involving patients in scheduling their follow-up appointments led to a significant increase in successfully scheduled appointments (from 66.7% to 87.7%) and improved attendance rates (from 43.9% to 62.9%).

The addition of a dedicated discharge scheduler reduced the administrative burden on residents, with 100% of participating residents reporting that this change improved their ability to care for patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Measuring Patient Preferences and Clinic Follow-Up Utilizing an Embedded Discharge Appointment Scheduler: A Pilot Study. Berger, RE., Yang, S., Weiner, J., et al.[2020]

Only 23% of calls to ambulatory clinics resulted in an appointment within one week, highlighting significant barriers to timely follow-up care for emergency department patients.

43% of initial calls to clinics were unsuccessful due to issues like clinic closures and busy signals, indicating that logistical challenges, rather than cost, are major obstacles in accessing necessary follow-up care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Nonprice barriers to ambulatory care after an emergency department visit. Vieth, TL., Rhodes, KV.[2008]

References

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

Outpatient care in emergency departments: feasibility and comparison of three strategies for follow-up. [2018]

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

Improving Outpatient Follow-Up Through Innovative Appointment Scheduling at Emergency Department Discharge. [2021]

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

Facilitating follow-up after emergency care using an appointment assignment system. [2019]

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

Improving Follow-up Attendance for Discharged Emergency Care Patients Using Automated Phone System to Self-schedule: A Randomized Controlled Trial. [2022]

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

Efficacy of a telephone follow-up system in the emergency department. [2019]

6. Spain pubmed.ncbi.nlm.nih.gov

[Adverse events in emergency departments. Review of reconsultations as a data source]. [2010]

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

Improving attendance at post-emergency department follow-up via automated text message appointment reminders: a randomized controlled trial. [2022]

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

A comparison of interventions to improve clinic follow-up compliance after a pediatric emergency department visit. [2019]

9. England pubmed.ncbi.nlm.nih.gov

Association between waiting times and short term mortality and hospital admission after departure from emergency department: population based cohort study from Ontario, Canada. [2022]

10. Netherlands pubmed.ncbi.nlm.nih.gov

Measuring Patient Preferences and Clinic Follow-Up Utilizing an Embedded Discharge Appointment Scheduler: A Pilot Study. [2020]

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

Nonprice barriers to ambulatory care after an emergency department visit. [2008]