ED Patient Follow-Up Calls

Donald Brock, MD, FACEPCalling patients to follow up on their visit to the ED is one of the most satisfying aspects of my practice in Emergency Medicine.

As emergency physicians, we are accustomed to being on the receiving end of negative feedback. However, we rarely get a chance to hear the positive. I guarantee if you call your patients back to follow up after discharge, you will likely get the positive feedback that is so important to us as clinicians.

Once you start, you’ll be hooked. The feedback from patients validates your hard work and dedication. It never ceases to make you feel good about what you do and the care you provide. From a physician’s perspective, follow-up calls are a great tool you can use to ward off burn-out in the stressful and often difficult practice of emergency medicine.

From an administrative perspective, I highly recommend that hospital leaders consider adding a patient call back program to their emergency department operations. Through our own call back programs, we have been successful in receiving patient feedback in real-time, improving the patient experience, and boosting physician performance and morale.

How do you get started?

There are many ways to conduct follow-up calls. Some groups or hospitals use nurses or other emergency department staff, while some use non-medical personnel. Others use physicians, but oftentimes these physicians are not calling back the patients that they themselves saw previously in the ED.

I highly recommend that you, as an emergency physician, call your own patients back yourself. While the other practices listed above are well-intentioned, the impact of these efforts is minimal in comparison to the direct doctor-to-patient follow-up call. Place yourself in the patient’s shoes and imagine the impact when, after your trip to the ED, the doctor who took care of you personally calls you to see how you’re doing.

When a physician contacts a patient, it makes a powerful statement that the physician truly cared about the patient’s experience. As a physician, it’s also an opportunity for immediate performance evaluation and a chance to make any hospital improvements that may be necessary.

When do you make the calls?
Do you call from the hospital, home, or your cell?
What number do you leave to call you back?

These are all very common questions from physicians who are unfamiliar with follow-up calls and reluctant to begin making them.

Personally, I make my calls from the hospital if I am working the next day. If I’m not working, I simply call from my cell phone. This has worked well for me and, while some physicians may fear that returning calls on their personal cell phone will lead to unwanted calls, I have never had a patient call my cell phone back because they were disgruntled and out to get me.

If using your own cell phone is a major concern to you personally, you can always block your number from showing up on the recipient’s caller ID (press *67 before dialing the number). Another option is to use an internet calling app on your smartphone—such as Google Voice—to create an entirely separate phone number you can use solely for the purpose of making patient calls.

But at the end of the day, let’s face it—with today’s technology, if someone really wants to find you and your phone number, there’s no stopping them anyway.

Which patients do you call back?

I would recommend calling discharged patients and certainly any patient you are concerned about for any reason. Also consider calling the ones who seemed less than pleased with their visit upon leaving—you might be surprised how easy it is to accomplish service recovery just by making the call.

How about patients with interesting problems, or the ones you couldn’t quite figure out and the diagnosis may become clearer with time? Absolutely! Potential liability patients? Yes. Patients who may be non-compliant? Definitely. And of course the patients you enjoyed talking to or visiting with, but just did not have enough time to spend with them. All of these scenarios present a great opportunity to connect with the patient during a follow-up call.

Factors to consider

What’s the best follow-up call process? A piece of paper with names and numbers? An electronic report?

Make sure you engage with your facility compliance department while developing this process. Personally, I keep the names and numbers in a password-protected file on my smartphone and discard them after use.

It is also imperative that you work with your hospital’s registration department to gain accurate patient contact information. After you start this process, it is likely you will quickly realize your registration department does not get accurate phone numbers from all patients. Stressing the importance of this practice can help improve the success of the patient call back program.

Do you record all the calls in the medical record?

Calls should be recorded in the medical record if specific medical advice or a change in therapy was given over the phone.

What do you say over the phone?

Develop some scripting that fits you, your personality, and your approach to patient care. Start with the basics: “Is now a good time to talk?” “How are you feeling?” “Thank you for allowing me to care for you.”

What if someone other than the patient answers the phone?

My recommendation is to not make call backs to anyone who would not necessarily want others to know that they were in the ED, should someone else happen to answer the phone (i.e. abuse cases, domestic violence, STDs, early pregnancy, etc.). Do not leave messages with anyone other than your patient. If your patient is not available to take the call, just simply say you will call back when the patient is likely to be available. Do not introduce yourself as your patient’s physician until you are certain the patient is available to take the call.

How do patients typically respond to these calls?

Surprised, really. “Wow! This doctor cares enough to call me?!” Another great aspect of follow-up calls is that you may discover new information that is important for you or your patient. It’s an opportunity to explain and reinforce, and patients appreciate that.

The phone call is also another chance to do service recovery on a difficult situation. My personal experience has been that the patient is so elated their physician called to check on them that they forget about the problem they had and just thank me for the call.

Impacts of a Patient Call Back Program

In conclusion, former ACEP President, Jay Kaplan, MD, FACEP, has said for years that, “Discharge follow-up phone calls improve patient care, patient satisfaction, and physician and nurse satisfaction.” When I was inexperienced in making the calls, I was skeptical at first and it took me a while to start the process. However, today I can say that I enthusiastically agree, having experienced the benefits myself firsthand. Since implementing the patient call back program, I have seen improved patient satisfaction scores as well as improved physician morale in the partnering hospital programs I oversaw as a Regional Medical Director within Island Medical Management.

If you are not making any follow-up calls currently, I would highly recommend you consider doing so.  Again, you will love hearing the positive feedback and appreciation from your patients. And as we are all aware, patient satisfaction is crucial to the success of the emergency department and may soon be tied to reimbursement. A patient call back program is a very valuable tool for us as emergency physicians to support this initiative.

Try it, you will like it!

Discover more ways to improve ED patient satisfaction

Article originally written by Donald Brock, MD, FACEP