By Donna Gorby, MLD, BSN, RN
According to the American Hospital Association, more than two-thirds of surgeries at community hospitals in the U.S. are now outpatient procedures.1 This shift is a big win for patients, offering faster recovery times and lower costs. Patients expect a smooth procedure, a hassle-free recovery, and clear communication – but short stays and limited contact with healthcare providers often leave them on their own to interpret post-op instructions and unsure about post-operative symptoms.
Betty’s Story
Betty, a 57-year-old woman with chronic hypertension and neuropathy, undergoes a simple outpatient procedure. She receives instructions during discharge, but she’s a bit inattentive. Once home, she begins experiencing pain at the site of the procedure.
Betty can’t find her discharge paperwork, but she remembers something about managing the pain with over-the-counter medication. Soon the pain spreads to other areas, leaving her fatigued and uncomfortable. She considers going to the emergency department, but she is unsure if it’s necessary. Betty tries again to locate the packet she received at discharge, but now the pain has become unbearable.
Fortunately, Betty receives a timely follow-up phone call from her hospital’s post-discharge care team. The nurse listens carefully as Betty describes her symptoms. Recognizing that the pain needs further attention, the nurse contacts Betty’s healthcare provider, who adjusts her pain management plan while considering her coexisting chronic conditions.
With the new regimen in place, Betty finds relief and avoids a trip to the emergency department.
Post-Discharge Phone Calls
Betty’s story illustrates the benefits of post-discharge care for both patient and provider. Betty is no longer in pain and knows she’s in good hands. The hospital avoids a readmission, CMS penalties, and negative perceptions about patient care. Multiple positive outcomes result from one simple phone call.
Hospitals are required to check in with patients within 24 to 72 hours of surgery, but it’s a best practice regardless of setting. Post-discharge follow-ups are most often conducted via phone call, and research shows that these calls play critical role in early detection and intervention. A 2024 study found that one in five patients identified a concern during a post-discharge call, and over 90% of those issues were resolved through phone consultations or outpatient visits.2 Another study in 2021 found that follow-up calls reduced readmissions by 13%.3
Post-discharge calls are especially effective when used for patients with chronic conditions, those administered general anesthesia, or patients whose procedures were longer, as these individuals are at a higher risk for complications.4 Providers can identify potential complications early, clarify complex discharge instructions, and verify whether patients are following their prescribed medication regimen.
These calls also foster better communication between patients and providers, improving trust and patients’ experience of care. Patients who receive follow-up calls report 31% fewer postoperative complaints compared to those who didn’t.5
Rethinking Post-Discharge Care
Phone calls remain essential, but today’s digital tools have opened the door to new and different ways to support recovery. Automated text messaging systems offer a fresh opportunity for busy outpatient settings, freeing up healthcare providers to focus on more complex issues by reducing the time spent on routine follow-up.
Following up via text reaches a larger pool of patients quickly. A 2019 study found that patients responded to texts at a much higher rate (87%) compared to phone calls (57%). Moreover, 54% of patients replied to text messages within just 10 minutes, allowing healthcare providers to address any emerging issues quickly. A combination of text messaging and phone calls achieved a 90% success rate in engaging patients, representing a significant improvement over phone calls alone.6
A hybrid model – combining the personal touch of phone calls with the efficiency of text messaging – offers the best of both worlds. Text messages can be used for routine check-ins, incorporating an escalation process that integrates phone calls when complex or urgent issues are identified. For patients who do not respond to text messages or report complications, a follow-up call should be required to ensure that no patient is left without support.
Regardless of your chosen approach, optimize your post-discharge follow-up practices with these key strategies:
- Refine patient education.
- Talk to patients before surgery about what to expect during recovery.
- Communicate clearly regarding what symptoms to watch for, how to manage them, and who to call for questions.
- Reinforce staff training.
- Teach staff to use follow-up communication as an opportunity to identify complications, clear up confusion, and assess patient needs.
- Use standardized assessments to ensure follow-ups include medication adherence, pain management, and signs of complications.
- Periodically audit for documentation of follow-up communication in patient records.
- Customize care. Tailor follow-up strategies based on the patient’s type of surgery, medical history, and specific risks.
- Invest in technology. Employ an automated text messaging system that complies with all relevant state and federal standards.
- Monitor and adapt. Regularly assess the effectiveness of your approach (phone calls or hybrid calls/texts) and use the data to improve care through your organization’s QAPI Program.
The Path Forward
Competent, compassionate post-discharge care is essential to both patient satisfaction and reduced organizational risk. In Betty’s story, a phone call mitigated what could have been an unfortunate situation. For a different patient, text messaging could have been just as effective. As technology continues to evolve, stay open to new communication tools (or combinations thereof) that could be a game-changer for your organization.
Donna Gorby, MLD, BSN, RN, is a standards interpretation specialist for acute care and critical access hospitals at Accreditation Commission for Health Care (ACHC). Prior to joining ACHC, she served in various leadership roles including vice president of quality and medical staff services, director of nursing, and regulatory compliance officer.
References
- Pickens, G., Imshaug, M., Moore, B., Karaca, Z., & Steiner, C. (2020). Surgeries in Hospital-Based Ambulatory Surgery and Hospital Inpatient Settings, 2014. Surgeries in Hospital-Based Ambulatory Surgery and Hospital Inpatient Settings, 2014 #223. https://hcup-us.ahrq.gov/reports/statbriefs/sb223-Ambulatory-Inpatient-Surgeries-2014.jsp
- Salley, K. E., Crawford, A. S., Robichaud, D. I., DeVivo, G., Steppacher, R. C., Schanzer, A., & Simons, J. P. (2024). Targeted use of postoperative discharge phone calls to reduce early readmission rates. Journal of Vascular Surgery, 79(5). https://doi.org/10.1016/j.jvs.2024.01.009
- Martins, M., Amaro, L., Brás, A., Coroa, M., & Barbosa, H. (n.d.). Individualized care and follow-up in outpatient surgery: A pilot study. Cureus. https://pubmed.ncbi.nlm.nih.gov/36788820/
- Cittanova, M.-L., Chauvier, S., Combettes, E., Boccheciampe, N., Gerbier, V., Leone, M., & Constantin, J.-M. (2021). Association of Automated Text Messaging with patient response rate after same-day surgery. JAMA Network Open, 4(1). https://doi.org/10.1001/jamanetworkopen.2020.33312
- Daniels, S.-A., Kelly, A., Bachand, D., Simeoni, E., Hall, C., Hofer, S. M., & Hayashi, A. (2016). Call to care: The impact of 24-hour post-discharge telephone follow-up in the treatment of surgical day care patients. The American Journal of Surgery, 211(5), 963–967. https://doi.org/10.1016/j.amjsurg.2016.01.015
- Leconte, D., Beloeil, H., Dreano, T., & Ecoffey, C. (2019). Post ambulatory discharge follow-up using automated text messaging. Journal of Medical Systems, 43(7). https://doi.org/10.1007/s10916-019-1278-5
