Post-Discharge Contact


 A 72-year-old man with no significant past medical history presented to the ER with a productive cough and fever. On arrival he was febrile, tachycardic to 116, and his pulse oximetry read 93% on room air. His chest x-ray revealed a left lower lobar infiltrate and his white blood cell count was elevated at 18,000. He was diagnosed with community-acquired pneumonia, treated with antibiotics, and admitted overnight to the hospitalist service. The next morning, he was afebrile, expressed interest in going home, and discharged with close primary care follow-up.

About 36-hours later, the patient was contacted by a callback nurse and reported to her that he had subsequently developed chest pain and shortness of breath. He was advised to return to the ER where a repeat chest x-ray revealed a parapneumonic left pleural effusion and he was admitted for suspected empyema. The patient eventually required surgical debridement via video-assisted thorascopy. He fully recovered after a 10-day admission and his discharge plan included home health visits, analgesics, antibiotics, hydration, and early follow-up.

A second nurse callback confirmed that the patient had filled his prescriptions and a home health nurse was scheduled to visit. Also, he had a follow-up appointment with the pulmonologist for the following week. Finally, the nurse relayed the radiology scheduling number regarding his follow-up chest x-ray. The patient expressed his appreciation with her assistance.

Noncompliance is common after hospitalization and a common reason for readmission. Upon hospital discharge, patients strongly benefit from early re-contact by a callback nurse who provides health coaching and assistance maneuvering the health care system. Re-contact immediately after an ER visit, procedure, or hospitalization significantly improves outcomes and satisfaction.