Using an interactive voice response system to improve patient safety following hospital discharge

BACKGROUND: Patients often experience complications when transitioning from hospital to home. These complications are frequently related to poor monitoring. An interactive voice response system (IVRS) could improve post-discharge monitoring. OBJECTIVE: To determine the feasibility and utility of an IVRS to monitor patients following hospital discharge. DESIGN: Prospective cohort study at an academic health sciences centre. PATIENTS: Consecutive internal medicine patients who had a touch-tone telephone, spoke English, had no cognitive impairments and were discharged home. MEASUREMENTS: Feasibility was defined as the proportion of patients reached by the IVRS and the proportion completing an IVRS-based survey. Utility was defined as the percentage of patients whose outcomes could have been changed by the IVRS. METHODS: We programmed the IVRS to call patients and administer a simple survey 48 hours after discharge. The survey's objective was to identify all patients with new health problems. Such patients were telephoned by a nurse to clarify and address the problem. RESULTS: We enrolled 77 patients who were predominantly male (68%), elderly (median age 65 years) and chronically ill (median number of co-morbidities = 3). The IVRS reached 45 of the 77 patients (58.4%). Forty patients (51.9%) answered all questions on the survey. Twenty patients (26%, 95% CI 17%-37%) indicated new or worsening symptoms, problems with their medications, or requested to talk to the clinic nurse. For 10 patients (13%, 95% CI 7%-22%), the IVRS could have made a difference in their outcome. CONCLUSION: Using an IVRS, we were able to identify several important new health concerns arising following hospital discharge. Subtle changes could increase the feasibility and utility of IVRS technology in improving post-discharge outcomes.