Postdischarge problems identified by telephone calls to an advice line

BACKGROUND: Problems experienced after hospital discharge can result in rehospitalizations and unscheduled urgent and emergent care. OBJECTIVE: To identify opportunities for improving discharge processes by examining calls to an advice line (AL). DESIGN: Prospective cohort. SETTING: A 500-bed, university-affiliated hospital. PATIENTS: Patients who called an AL between September 1, 2011 and September 1, 2012 and reported being hospitalized within 30 days. INTERVENTION: None MEASUREMENTS: Caller characteristics, timing of calls, nature of reported problems. RESULTS: Over 1 year the AL received calls from 308 unique patients who were hospitalized or had outpatient surgery within 30 days preceding the call. Thirty-one percent and 47% of calls occurred within 24 or 48 hours of discharge, respectively. Sixty-three percent came from surgery patients despite surgery patients accounting for only 38% of the discharges. The most common issues were uncontrolled pain, questions about medications, and aftercare instructions (eg, the care of surgical wounds). The rates of 30-day readmissions and urgent or emergent care visits were higher for patients who called the AL than for those who did not (15% vs 4% and 30% vs 7%, respectively, both P < 0.0001), but sample sizes were too small to accommodate robust matching or multivariate analysis. CONCLUSIONS: Problems described in calls by patients to an AL identified several aspects of our discharge processes that needed improvement. Patients calling an AL following discharge may be at increased risk for 30-day rehospitalization and urgent or emergent care visits.