Boulder-based University of Colorado Department of Surgery developed a new discharge protocol that reduced the number of unnecessary postoperative ED visits by 48.8% in six months.
In 2022, pediatric urology surgeons noticed an increase in the number of patients who returned to the ED following a urologic surgery, according to a Dec. 2 news release from the university.
"We were finding a significant portion of children who were coming to the ED and were discharged just with reassurance," Kelly Harris, MD, assistant professor of urology, said in the release. "They often were having a very long ED stay — and the cost of an ED visit as well — that could have been avoided with either a phone call, sending us a picture, or a quick clinic visit. When you have a problem like this, it's easy to say, 'The parents need to do better; the surgeons need to do better.' But from a quality improvement standpoint, we tried to look at it more globally and see if there was anything we could do to make this problem improve."
Urologists made three changes to the discharge protocol to reduce unnecessary ED visits within 30 days:
1. Changed discharge instructions to make sure families were aware of the phone number they can call anytime to ask questions to a live person.
2. Created space in the clinics for same-day or next-day appointments to evaluate urgent concerns.
3. Created a protocol that includes a decision tree for nurses who answer the phone line to clarify who should go to a clinic, to urgent care or to the ED. It also created a protocol to prepare ED staff when a patient is routed to the hospital.
Six months after implementing the new protocols, the median inappropriate 30-day ED return rate sank to 2.2% — a 48.8% drop from baseline.
The system plans to continue making changes to the protocol to improve triage and track the proportion of patients who use urgent care clinics for postoperative concerns.