Project BOOST

1. Project BOOST 72-hour Telephone Follow-Up Instruction Amit Patel, MD, FACP, SFHM ChithraPerumalswami, MD

2. How to perform calls

3. Purpose What is the purpose of your call program? Reduce readmissions, improve follow-up adherence, and improve patient satisfaction. Pick the purpose first in order to choose the correct metrics to monitor, correct training to provide, and correct staff member to perform the call.

4. Who • The key is to determine who will make the calls: • Pharmacists • Nurses • MD/DOs • Primary Care RNs • Outsourced company • Patient care techs • Others?

5. Who • Whomever is making the calls needs: • Time • Information • Guidance • Training

6. Who Who are the patients being targeted? What characteristics of the patients make them good candidates for calls? Are you going to call every discharge? Is there a disease-oriented subset who make sense to target?

7. Time • How long do calls typically last? • 5-30 plus minutes can be typical. • 5 minutes suggests not enough information is being gathered or provided. • Greater than 30 minutes provides concern for staff resource utilization and patient readiness for discharge. How long is best determined by your facility and your patients.

8. Information • Staff will need to gather the following pieces of information to provide optimal follow-up calls: • Contact information • Interpreter • Discharge summary or other source of clinical information • Discharge medication list • Call documentation forms or software

9. Guidance Simulate, Simulate, Simulate Build disease-specific scenarios and plans of action/education/guidelines Provide the opportunity to observe an experienced caller perform the calls Provide clear expectations for necessary actions when warranted Build clear lines of “Triage”

10. Training The amount of time training will depend on the experience level of the person performing the call. How many calls are observed? E-Learning scenarios Role-playing Information packets

11. The Call Scripted introductions are HELPFUL. Assess the patient’s readiness for the call: “Do you have time to speak at this moment about your recent hospital stay?” Preparing the patient to receive the call prior to discharge will set the expectation to improve this process.

12. The Call Health assessment Medication check Follow-up appointments made or completed Pending laboratory studies Coordination of discharge home services Review what to do for changes in health status https://www.bu.edu/fammed/projectred/newtoolkit/5.%20How%20to%20Conduct%20a%20Post-discharge%20Follow-up%20Phone%20Call%204.15.11.pdf

13. Support • Provide: • Sympathy • Support • Reassurance • Timely follow-up for any issues which require urgent attention Use Teachback to verify understanding

14. Follow-up Provide feedback to caregivers as needed Set clear expectations for others tasked with follow-up needs Document concerns, compliments, and other items which are important for the feedback process

15. Metrics • If you measure patient satisfaction only, then consider: • Measuring nursing unit level information on HCAHPS specific questions • Press Ganey survey data • RAND survey tools • Studer surveys

16. Metrics • Process Metrics • Did the patient receive understandable instructions at discharge? • Is the patient able to perform Teachback? • Does the patient understand why he/she was hospitalized? • Was the patient’s in-hospital comforts and needs met satisfactorily? • Does the patient want to compliment a specific member of the staff?

17. Metrics • Outcomes Metrics: • Readmissions • ER Visits • Completion of follow-up appointments • Obtaining appropriate follow-up appointments • Length of Stay (either index admit or on readmit)

18. Follow-up Telephone Calls Every site is unique Every patient is unique Success is not measured at one time but over the course of time Monitor and Control the process Make adjustments and OWN the process Plan ahead to achieve your goals!!!