Discharge Planning for Elderly Patients in the Emergency Department: Use of a Brief Phone Call After Discharge to Improve Medication Utilization and Physician Follow-up

• Whether patient obtained medications prescribed at their discharge from ED [ Time Frame: 5-8 days after discharge from ED ] [ Designated as safety issue: No ]
  
• Whether patient is using medications that were prescribed at their ED discharge correctly [ Time Frame: 5-8 days after discharge from ED ] [ Designated as safety issue: No ]
  
• Whether the patient arranged a follow-up appointment with their primary care provider [ Time Frame: 5-8 days after discharge from ED ] [ Designated as safety issue: No ]
  
• Whether patient attended visit with their primary care provider after discharge from the ED [ Time Frame: 30-35 days after discharge from ED ] [ Designated as safety issue: No ]
  

• Patient's satisfaction with ED visit [ Time Frame: 5-8 days after discharge from the ED ] [ Designated as safety issue: No ]
  
• Return to the ED within 30 days of initial visit [ Time Frame: 30-35 days after discharge from ED ] [ Designated as safety issue: No ]
  
• Cost of the intervention [ Time Frame: 35 days after last patient enrolled ] [ Designated as safety issue: No ]
  

Older patients seen in the ED are at high risk of functional decline and return visits to the ED. Previous studies have shown that a comprehensive assessment by a geriatric specialist at the time of discharge from the ED along with extensive integration with home services and/or referral to community services can decrease functional decline and return visits to the ED as well as increase patient satisfaction, but this intervention is resource intensive requiring a geriatric discharge specialist to be available to the emergency department 24 hours a day/ 7 days a week. It is also known that in other patient populations telephone reminders to make follow up appointments can increase rate of follow up and that comprehension of discharge instructions is the primary barrier to compliance with discharge instructions. It has been shown that telephone follow-up interviews are feasible for geriatric patients discharged from the ED, and that many elderly patients discharged from the ED do not understand their discharge instructions or attend follow-up appointments. However, there are no published studies evaluating whether a follow up telephone call after discharge from the ED can improve patient compliance with the medical treatment plan including obtaining follow - up appointments and obtaining prescribed medications as well as using them appropriately. We seek to determine if we can increase compliance with medications and outpatient follow up with a phone call from a nurse provider 1-3 days after discharge.