The effectiveness of nursing telephone consultation program for discharged patients in the emergency department

Although the cost-effectiveness of telephone nursing consultation has implemented in many developed countries for more than 30 years, very few studies have been conducted in Taiwan. Therefore, the purposes of this study were 1) to develop a telephone nursing consultation program (TNCP) for discharged patients in the emergency department (ED), 2) to analyze what were the tope leading 20 problems or symptoms reported by patients while they visited the ED, 3) to compare the outcome differences before and after implementing the TNCP. The design was descriptive. A TNCP in the ED was implemented at a 700-bed of medical center in Taipei. The samples were selected for those who had visited and discharged from ED. Patients were excluded if a person with accident, life-treating situation, or having mental problems. Weekly meeting was arranged to allow questions to be answered and written protocols to be revised before implementations. All patients' charts in 2003 were reviewed to find top 20 signs and symptoms. The satisfaction questionnaire was developed by the primary investigator and included 10 questions on a 5-point Likert-type scale. All data were analyzed using the Statistical Package for the Social Science/PC+ (SPSS for Windows 12.0, Chicago, IL). Descriptive analyses such as number, mean, standard deviation, ratio, rank, and percentage were used to analyze nurses' demographics and level of satisfaction, number of ED or outpatient visits, and readmission rate within 21 days after patient called. One-way ANOVA was used to compare the differences between pre-TNCP and post-TNCP. At the implementing phase, 9 nurses (4 were university graduates and 5 junior college graduates) were initially chosen to be TNCP nurses for this study. A special training such as computer and communication skills, protocols and documentation used, and role-play was provided to those nurses before TNCP was implemented. The TNCP was decided to open from Monday to Sunday and between 9 AM to 9 PM based on nurses' workload and hospital financial abilities. The results were that the mean working experience for nurses was 6.7 years. The top leading 20 problems or symptoms reported by ED patients were included adult abdominal pain, child fever, adult fever, laceration, dyspnea, chest pain, dizziness, child abdominal pain, adult nausea and vomiting, child nausea and vomiting, abrasion, adult diarrhea, child diarrhea, headache, arm and hand problems, head injury, palpitation, urinary difficulty, abdominal distension, mouth problems. During 3-month study period, only 54 calls were received and yielded an utilization rate was 0.61%, which was low. On average, the consulting time was 6.1 minutes. The advises used by TNCP nurses were for home management (n=21 calls; 38.9%), for emergency visits within 2-4 hours (n=8 calls: 14.8%), and for outpatient visits within 24 hours (n=25 calls; 46.3%). The experiences about being a TNCP nurse, they reported that the TNCP was very useful to assist patients after they discharged from ED, and the protocols and documentations were friendly and easy to follow. Overall, about 85% of patients felt satisfied with the TNCP and the level of satisfaction was increased from 3.12 points to 3.18 points between pre-implementing and post-implementing of the TNCP. To conclude, the findings indicated that the TNCP was effective, not only can expand the roles and functions of nurses, but also improve ED patients' satisfaction. For the future, we hope the TNCP can be extended to all departments at study hospital and to develop a call center to serve more ED patients.