Telephone Follow-Up for Older Adults Discharged to Home
from the Emergency Department: A Pragmatic Randomized
Kevin J. Biese, MD, MAT,*
Jan Busby-Whitehead, MD,
Jianwen Cai, PhD,
Sally C. Stearns,
Ellen Roberts, PhD, MPH,
Paul Mihas, MA,
Doug Emmett, BA,
Qingning Zhou, PhD,
Franklin Farmer, MBA,
and John S. Kizer, MD
BACKGROUND/OBJECTIVES: Telephone calls after dis-
charge 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 regis-
tered 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 south-
east United States.
PARTICIPANTS: Individuals aged 65 and older dis-
charged 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: medica-
tion acquisition, postdischarge instructions, and obtaining
physician follow-up. Control subjects received a satisfac-
tion 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. J
Am Geriatr Soc 0:1–7, 2017.
Key words: emergency medicine; care transitions;
rehospitalization in elderly
n the ﬁrst few months after discharge from the emer-
gency department (ED), adults aged 65 and older are at
risk of adverse events, including rapid return to the ED,
hospitalization, decline in capacity to perform activities of
daily living (ADLs), and death.
These outcomes may
stem from inadequate care transitions from the ED, includ-
ing poor communication of discharge instructions,
delays in return appointments to a primary care physician
and unrecognized signs of complications.
strong is the belief that better discharge planning can
improve the quality of aftercare for individuals recently
discharged from the ED that the Centers for Medicare and
Medicaid Services proposed rules in 2015 to apply dis-
charge planning requirements to individuals being dis-
charged from the ED.
As the number of older adults
seeking care in EDs has increased rapidly,
U.S. healthcare system has emphasized avoidance of repeat
admissions and ED visits,
these poor outcomes after dis-
charge from an ED have become a focus of concern.
Numerous healthcare systems have searched for prac-
tical ways to provide better care after discharge from the
hospital or ED.
Telephone calls have been recognized
From the *Department of Emergency Medicine, University of North
Center for Aging and Health, Department of Medicine;
Department of Biostatistics;
Department of Health Policy and
Howard W. Odum Institute for Research in Social
Science, University of North Carolina at Chapel Hill, Chapel Hill, North
Address correspondence to Kevin Biese, Department of Emergency
Medicine, University of North Carolina, 170 Manning Drive, POB First
Floor, Chapel Hill 27599-7594, NC. E-mail: email@example.com
See related editorial by Hwang et al.
JAGS 0:1–7, 2017
© 2017, Copyright the Authors
Journal compilation © 2017, The American Geriatrics Society 0002-8614/18/$15.00
30 days. Clinicaltrials.gov identifier: NCT01893931z. J
Am Geriatr Soc 66:452–458, 2018.
JAGS 66:452–458, 2018
2017, Copyright the Authors
2017, The American Geriatrics Society 0002-8614/17/$15.00