Emergency department nurse call back: A quality improvement project

Background: Early detection of clinical deterioration after discharge from the Emergency Department may facilitate timely intervention and improve patient outcomes. Methods: A quality improvement project to evaluate nurse call back offered to all patients within 72 h of discharge to community (usual residence) from an Emergency Department. All patients of all ages that were assessed, managed by a physician and discharged to their home from an Emergency Department were eligible. A standard algorithm and flow chart was used for all call backs. Call back refers to the follow up phone call by a Registered Nurse from the Emergency Department following patient discharge. The aim of call back is to enhance the early recognition of deteriorating patients. Project outcomes were the proportion of patients who were contacted by phone by a nurse post discharge and the proportion of patients that met deterioration criteria. The project was conducted over a six month period. Results: There were 1139 patients eligible. Call back was attempted for 893 patients of which 716 (80%) were contacted. Deterioration was identified in 34 of 716 (5%) patients, two were advised to attend their general practitioner, and 32 were directed to present to an Emergency Department. Of the 32 recalled patients, 26 represented to the original Emergency Department and 12 were admitted following the call back, an admission rate of 46% (95% CI:28.7-64.5) of those that represented. Conclusions: It was feasible to implement a nurse call back in an Emergency Department. Nurse call back has the potential to reduce times to re-presentation of an emergency, thereby mitigating adverse events, preventing complications. Further evaluation is warranted.