Contact After Emergency Department Discharge by a Telehealth Transition of Care Program Is Associated With Reduced Emergency Department Revisit Rate

TL;DR

A telehealth program contacting patients after emergency department discharge was linked to fewer ED revisits within 7 and 30 days.

Contribution

This study demonstrates that a telehealth transition of care program can reduce ED revisit rates when patients are contacted within 48 hours.

Findings

Patients contacted by the program had a 7-day ED revisit rate of 4.1% versus 6.4% for those not contacted.

The 30-day ED revisit rate was 10.0% for contacted patients versus 12.8% for those not contacted.

Optimal outreach timing was found to be more than 72 hours post-discharge and during weekday late afternoon/evening hours.

Abstract

Objective

The effectiveness of transition of care programs for patients discharged from the emergency department (ED) varies. This study aimed to evaluate the impact of the White Plains Hospital Cares (WPH Cares) program on repeat ED visits within 7 and 30 days after discharge. Secondary objectives included assessing patient characteristics affecting return rates, the optimal timing for telehealth outreach, and the best time to contact patients after ED discharge.

Methods

This cohort study analyzed data from patients discharged from the ED to home between May 2021 and April 2023 at a community hospital. Data analysis was conducted from March 2023 to July 2024. All discharged patients were eligible for contact by the WPH Cares program, which involves a team of nurses and social workers aiming to reach patients within 48 hours. The WPH Cares structured assessment provided follow-up support, including appointment navigation, reviewing discharge instructions, facilitating medication access, home services, and delivering disease-specific care. The primary outcome was ED return visits at 7 and 30 days.

Results

During the study period, 106,888 patients were discharged home from the ED. The WPH Cares team attempted to contact 93,933 (87.9%) of these patients, successfully reaching 52,210 (48.8%). Patients successfully contacted by WPH Cares had a lower likelihood of returning to the ED within 7 days (4.1% vs. 6.4%; OR 0.69, p<0.0001) and within 30 days (10.0% vs. 12.8%; OR 0.82, p<0.0001) compared to those not contacted.

Conclusions

Among ED patients at a single community hospital, successful contact by a multidisciplinary telehealth transitional care program was associated with lower 7- and 30-day revisit rates. Optimal outreach timing was >72 hours post-discharge and during weekday late afternoon/evening hours. These observational findings require confirmation with balanced comparison groups and prospective designs.

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