Patients’ post-care connection

For some hospital patients, care stops once they exit the sliding glass doors. But for those discharged from Toronto East General Hospital in East York, a follow-up phone call at home makes all the difference.
The Post Discharge Phone Call Program garnered TEGH the 2010 Ontario Hospital Association’s (OHA) Patient Safety Award. Implemented in February 2008, the program ensures all patients are called at home within 48 hours of their release from inpatient care. The manager of the Transition and Continuity department at TEGH and the co-ordinator of the program, Joanne Fulton, said the feedback from patients has been positive.
“We’re talking to people not six months later; we’re talking to them two days after they’ve gone home, and sometimes less. So their hospital experience is fresh in their minds,” Fulton said. “I would say on average about 96 per cent of the patients are satisfied with the care they receive at our hospital.”
East General’s submission was one of 140 for the award. According to the OHA, Fulton said, the decision to give TEGH the Patient Safety Award was unanimous.
“One of the examples we gave was an elderly woman that a nurse called was very confused. The nurse looked at all of her medications and saw that she was on a narcotic, and phoned a neighbour, and then ended up phoning a family doctor,” she said. “The family doctor said, ‘I know her very well and I’m going to go do a home visit,’ and she did. And of course the nurse followed up with the doctor after.”
The program was initially started as a late-career nurse initiative. Nurses aged 55 and older were taken from bedside nursing for a day and reassigned to the less strenuous job of contacting the patients. The phone calls are still made by nurses, who make sure the discharged patients understand their medications, know when to fill prescriptions and confirm follow-up appointments.
“This initiative harvested really experienced nurses who were able to connect with patients very easily and were able to do that over the telephone,” Fulton said. “So it took them away from bedside nursing, which can be a little hard at times, but they were fully utilizing their clinical experiences and capabilities with patients over the phone.”
After the clinical questions are answered, the nurses also ask questions about the service TEGH provided for the patients. Fulton said this helps the hospital workers know what they can improve upon. For her, it’s an all-around win for the hospital.
“We can even utilize nurses who are off work because of injuries, and they come back on modified work. This allows them to keep their clinical skills and connect with patients still and gently get back into the workforce,” she said. “It’s definitely a win for the patients, but it’s also a win for the nurses, and a win for the hospital.”
Expanding the program to other areas of the hospital, such as mental health, is something Fulton hopes to implement within the near future. She would also like to begin phoning day surgery patients who get discharged on the same day they have surgery.