Development and implementation of an emergency department telephone follow‐up system

Implementing a telephone follow‐up system after a patient's emergency department (ED) visit is challenging, but it may improve patient safety and care. This study's objective was to describe the development and implementation of a comprehensive ED telephone follow‐up system over a 9‐year period. Discharged patients who received a follow‐up telephone call within 48 hours of their ED visit included all pediatric patients, those who left without being seen by a provider, and any adult patient with a “high‐risk chief complaint,” which was defined as a headache, visual problem, chest pain, dyspnea, abdominal pain, syncope, trauma, and neurological‐related problems. There were 127 524 cases that met criteria to receive a follow‐up call, with 138 331 attempted calls being made and 46 114 (36.2%) cases successfully followed up. Forty‐two percent of pediatric cases and 16% of patients who left without being seen were successfully contacted with a follow‐up call; 1.6% of cases were referred to the CQI Committee. In the 9 years prior and after implementation of this follow‐up system, there were 3.5 (95% confidence interval [CI] = 2.1–5.9) and 2.5 (95% CI = 1.3–4.5) medical malpractice lawsuits per 100 000 ED patient visits, respectively; this represented a 28.6% reduction. A comprehensive telephone follow‐up program can be developed and implemented utilizing available resources.