P2D260: Quality Improvement Project to Improve Emergency Department and Urgent Care Follow up of Primary Care Patients in the Medical Home

Purpose/Objectives: Parents often take their children to the emergency department (ED) or an urgent care center (UCC) for common illnesses that can be treated in the primary care medical home. Follow-up is crucial in preventing adverse outcomes, ensuring adherence to prescribed medications, reducing return ED/UCC visits by arranging follow-up visits, and improving parental education. The purpose of this quality improvement project was to establish a resident-led call back system at our primary care sites (hospital-based and community-based) to assess patients following an ED/UCC visit and to ensure adequate improvement and follow-up plans. During the period of August 2022-February 2023, our objectives were to 1) Call 50% of patients seen in the ED/UCC and 2) Have 50% of patients needing follow-up seen within 7 days of the call.

Design/Methods: We used Plan-Do-Study-Act cycles to design, implement, and iteratively improve our processes. In August 2022, we implemented a follow-up callback system whereby patients seen in the ED/UCC the day prior received a call from a physician. A checklist was built into the electronic health record (EHR) that also served as documentation. Attendings made calls in August 2022, and residents on their primary care rotation transitioned to making the calls in November 2022. Callback instructions were posted at the residents’ workstation in January 2023. In February 2023, a resident champion was assigned as a peer mentor for the initiative. Outcomes measured monthly through data extracted from the EHR included percentage of: callbacks made, patients recommended to follow-up, patients who required follow-up seen within 7 days of their callback, illness trajectory, and patients needing prescriptions resent.

Results: There were 3,646 ED/UCC visits amongst our primary care patients between August 2022-February 2023. A total of 1,206 patients (33%) were called back (Figure 1). Of those, follow up was recommended for 167 patients (14%) (Figure 1). Of those 167 patients, 43% followed up within 7 days (Figure 2), with a mean follow-up time of 5 days. The most common reasons for visits were fever (35%), cough (25%), and vomiting (20%). 82% reported improvement at the time of the follow-up call.

Conclusion/Discussion: We successfully implemented a primary care callback system for patients seen in the ED/UCC. We did not attain our goal for patient callbacks, however we found that the majority of patients were improving and only a minority of patients required follow-up visits. Thus, as a next step, we will explore a more tailored approach, prioritizing callbacks to patients identified as having highest needs. Additional next steps include providing additional patient education around ED/UCC vs primary care use and assessing changes to ED/UCC visit volume.