Telephone Follow‐Up for Older Adults Discharged to Home from the Emergency Department: A Pragmatic Randomized Controlled Trial

Background/Objectives Telephone calls after discharge from the emergency department (ED) are increasingly used to reduce 30‐day rates of return or readmission, but their effectiveness is not established. The objective was to determine whether a scripted telephone intervention by registered nurses from a hospital‐based call center would decrease 30‐day rates of return to the ED or hospital or of death. Design Randomized, controlled trial from 2013 to 2016. Setting Large, academic medical center in the southeast United States. Participants Individuals aged 65 and older discharged from the ED were enrolled and randomized into intervention and control groups (N = 2,000). Intervention Intervention included a telephone call from a nurse using a scripted questionnaire to identify obstacles to elements of successful care transitions: medication acquisition, postdischarge instructions, and obtaining physician follow‐up. Control subjects received a satisfaction survey only. Measurements Primary outcome was return to the ED, hospitalization, or death within 30 days of discharge from the ED. Results Rate of return to the ED or hospital or death within 30 days was 15.5% (95% confidence interval (CI) = 13.2–17.8%) in the intervention group and 15.2% (95% CI = 12.9–17.5%) in the control group (P = .86). Death was uncommon (intervention group, 0; control group, 5 (0.51%), 95% CI = 0.06–0.96%); 12.2% of intervention subjects (95% CI = 10.1–14.3%) and 12.5% of control subjects (95% CI = 10.4–14.6%) returned to the ED, and 9% of intervention subjects (95% CI = 7.2–10.8%) and 7.4% of control subjects (95% CI = 5.8–9.0%) were hospitalized within 30 days. Conclusion A scripted telephone call from a trained nurse to an older adult after discharge from the ED did not reduce ED or hospital return rates or death within 30 days. Clinicaltrials.gov identifier: NCT01893931z. See related editorial by Hwang et al.