LR12 / Clinical Risk Management (CRM) practice on post discharge monitoring

Type of Patient Safety Practice
Clinical Practice (CP)
Related practices from PaSQ database
“Best fit” category of the reported practice
Communication and documentation
Patient safety theme the SCP/clinical risk management practice is aimed at
Post discharge monitoring
Objective of the CRM practice
Available evidence suggests that patient care following discharge from hospital is problematic and a failure to monitor patient’s conditions and treatments predisposes them to post-discharge complications[15,16].
Short description of the CRM practice, including any references for further information
Interactive voice response systems (IVRS) are information technologies that allow people to interact with a database using a standard telephone and could be used to monitor post-discharge patients. Surveys are administered using IVRS-initiated telephone calls in which a pre-coded dialogue prompts the patient for response. Patients answer by pressing the keypad on their telephone or through voice recognition software. Patients requiring additional follow-up could be identified through this method, thefore minimising the amount of time required by skilled proffesionals to contact patients[10].
Innovator of the SCP, country of origin
Involved health care staff
Nurse (Medical liaison nurse)
Tested in which countries/health care systems, health care context(s) and/or clinical specialty/specialties, including references
Tertiary care hospital/internal medicine[10]
United States/ Preventive health/ immunization uptake,[1,2]
United States / Geriatric care / disruptive behaviours related to Alzheimer’s disease (AD) [6].
Summary of evidence for effectiveness, including references
Moderate improvements in preventive healthcare practices[1-3] and in chronic disease management[4-8] have been reported from studies of Interactive voice response systems (IVRS). In addition, intervention studies involving discharge planning have not found consistent benefits in terms of reducing post discharge adverse outcomes[9], maybe post discharge monitoring interventions could have a greater effect on outcomes[10]. Although IVRS is common in business, their impact on health care delivery have not been well studied.
Summary of evidence for transferability (transferability across health care systems or health care contexts or clinical specialties), including references
IVRS has diverse applications in medical care though the evidence is limited[11]. The reliability and availability of the IVRS make it attractive to use for reminders and follow-up. IVRS has been exploited in primary care to provide follow-up and feedback to providers[12] and assess medication adherence in HIV patients [13,14].
Summary of available information on feasibility, including references
Using an IVRS to identify which patients require additional attention is theoreticaling appealing
Existing implementation tools, including references
Potential for/description of patient involvement in the CRM practice, including references
Patients answer the automated questions on the IVRS phone by pressing the keypad of their telephone or through voice recognition software[10].
Bibliography (for each reference: author(s), year, title, journal/internet link, page(s))
[1] LeBaron CW, Starnes DM, Rask KJ (2004) The impact of reminder-recall interventions on low vaccination coverage in an inner-city population. Arch Pediatr Adolesc Med 158:255-261

[2] Leirer VO, Morrow DG, Pariante G, Doksum T (1989) Increasing influenza vaccination adherence through voice mail. J Am Geriatr Soc 37:1147-1150

[3] Pinto BM, Friedman R, Marcus BH, Kelley H, Tennstedt S, Gillman MW (2002) Effects of a computer-based, telephone-counseling system on physical activity. Am J Prev Med 23:113-120

[4] Alemi F, Stephens RC, Javalghi RG, Dyches H, Butts J, Ghadiri A (1996) A randomized trial of a telecommunications network for pregnant women who use cocaine. Med Care 34:OS10-OS20

[5] DeMolles DA, Sparrow D, Gottlieb DJ, Friedman R (2004) A pilot trial of a telecommunications system in sleep apnea management. Med Care 42:764-769

[6] Mahoney DF, Tarlow BJ, Jones RN (2003) Effects of an automated telephone support system on caregiver burden and anxiety: findings from the REACH for TLC intervention study. Gerontologist 43:556-567

[7] Stuart GW, Laraia MT, Ornstein SM, Nietert PJ (2003) An interactive voice response system to enhance antidepressant medication compliance. Top Health Inf Manage 24:15-20

[8] Weiler K, Christ AM, Woodworth GG, Weiler RL, Weiler JM (2004) Quality of patient-reported outcome data captured using paper and interactive voice response diaries in an allergic rhinitis study: is electronic data capture really better? Ann Allergy Asthma Immunol 92:335-339

[9] Parkes J, Shepperd S (2000) Discharge planning from hospital to home. Cochrane Database Syst RevCD000313

[10] Forster AJ, van WC (2007) Using an interactive voice response system to improve patient safety following hospital discharge. J Eval Clin Pract 13:346-351

[11] Biem HJ, Turnell RW, D’Arcy C (2003) Computer telephony: automated calls for medical care. Clin Invest Med 26:259-268

[12] Willig JH, Krawitz M, Panjamapirom A, Ray MN, Nevin CR, English TM, Cohen MP, Berner ES (2013) Closing the Feedback Loop: An Interactive Voice Response System to Provide Follow-up and Feedback in Primary Care Settings. J Med Syst 37:9905

[13] Hettema JE, Hosseinbor S, Ingersoll KS (2012) Feasibility and reliability of interactive voice response assessment of HIV medication adherence: research and clinical implications. HIV Clin Trials 13:271-277

[14] Rodrigues R, Shet A, Antony J, Sidney K, Arumugam K, Krishnamurthy S, D’Souza G, DeCosta A (2012) Supporting adherence to antiretroviral therapy with mobile phone reminders: results from a cohort in South India. PLoS One 7:e40723

[15] Forster AJ, Murff HJ, Peterson JF, Gandhi TK, Bates DW (2003) The incidence and severity of adverse events affecting patients after discharge from the hospital. Ann Intern Med 138:161-167

[16] Forster AJ, Clark HD, Menard A, Dupuis N, Chernish R, Chandok N, Khan A, van WC (2004) Adverse events among medical patients after discharge from hospital. CMAJ 170:345-349

Any additional information on the CRM (e.g. implementation barriers and drivers)