Targeted Use of Postoperative Discharge Phone Calls to Reduce 30-Day Hospital Readmission Rates After Vascular Surgery

Postoperative readmissions are common and costly. Office-initiated phone calls to patients shortly after discharge may identify concerns and allow for early intervention to prevent readmission. We sought to evaluate our 30-day readmission rate after the implementation of a standardized postoperative discharge phone call (PODPC) intervention, compared with a historical pre-intervention rate. The electronic medical record identified a historical pre-intervention cohort (July 2018- July 2019) and 30-day readmission rate. During July 2020 to July 2021, postoperative patients were prospectively identified at 48 hours post-discharge. Medical assistants performed PODPCs, administering a survey designed to identify medical/surgical issues that could signify a complication. Demographics, comorbidities, and procedure type were obtained retrospectively. Descriptive statistics were used to evaluate PODPC responses, frequency of escalation, readmission, and reasons. A χ2 analysis was used to determine the association between PODPC and readmission between the pre- and intervention cohorts. Predictors of 30-day readmission were modeled with multivariate logistic regression. Of 411 PODPCs conducted, 106 patients (25.7%) reported “not feeling well; having concerns.” Eighty-four PODPCs (20.4%) triggered escalation to a nurse practitioner (NP). Sixty (14.6%) were counseled over the phone by an NP, 16 (3.9%) were brought into clinic, six (1.4%) were sent to the emergency department, and two (0.49%) did not answer the NP call. Of 411 patients, 16.5% (n = 68) were readmitted within 30 days (Fig). Comparatively, the historical cohort readmission rate was 26.6% (n = 358); this was significantly different on χ2 independence test (P < .0001). On multivariable analysis, chronic obstructive pulmonary disease (odds ratio [OR], 1.92; 95% confidence interval [CI], 1.01-3.65; P = .046) and “feeling run down; having difficulty with movement; needing assistance for most activities” (OR, 3.94; 95% CI, 2.09-7.43; P < .0001) were predictive of 30-day readmission when controlling for procedure type. Although readmission remained common (>15%), patients who received PODPC had significantly different readmission rates than those in the preintervention cohort. One fifth of PODPCs identified a concern, but >90% of these were managed by an NP by phone or in clinic. This PODPC intervention holds promise as a viable mechanism for reducing readmission.