Authored by: Donald Brock, MD, FACEP — Regional Medical Director
Calling patients to follow up on their visit to the ED is one of the most satisfying aspects of my practice in Emergency Medicine.
As emergency physicians we are accustomed to being on the receiving end of negative feedback, but we rarely get a chance to hear the positive. I guarantee if you call your patients back to follow up after discharge, you will likely get the positive feedback that is so important to us as clinicians.
Once you start, you’ll be hooked. The feedback from patients validates your hard work and dedication, and never ceases to make you feel good about what you do and the care you provide. From a physician’s perspective, follow up calls are a great tool you can use to ward off burn-out in the stressful and often difficult practice of emergency medicine.
From an administrative perspective, I highly recommend that hospital leaders consider adding a patient call back program to their emergency department operations. Through our own call back programs at IMM, we have been successful in receiving patient feedback in real time, improving the patient experience, and boosting physician performance and morale.
So how do you get started?
There are many ways to conduct follow up calls. Some groups or hospitals use nurses or other emergency department staff, while some use non-medical personnel. Others use physicians, but oftentimes these physicians are not calling back the patients that they themselves saw previously in the ED.
I highly recommend that you, as an emergency physician, call your own patients back yourself. While the other practices listed above are well intentioned, the impact of these efforts is minimal in comparison to the direct doctor-to-patient follow up call. Place yourself in the patient’s shoes and imagine the impact when, after your trip to the ED, the doctor who took care of you actually calls you personally to see how you’re doing.
When a physician contacts a patient, it makes a powerful statement that the physician truly cared about the patient’s experience. As a physician, it’s also an opportunity for immediate performance evaluation and a chance to make any improvements that may be necessary.
When do you make the calls?
Do you call from the hospital, home, or your cell?
What number do you leave to call you back?
These are all very common questions from physicians who are unfamiliar with follow up calls and reluctant to begin making them.
Personally, I make my calls from the hospital if I am working the next day. If I’m not working, I simply call from my cell phone. This has worked well for me and, while some physicians may fear that returning calls on their personal cell phone will lead to unwanted calls, I have never had a patient call my cell phone back because they were disgruntled and out to get me.
If using your own cell phone is a major concern to you personally, you can always block your number from showing up on the recipient’s caller ID (press *67 before dialing the number). Another option is to use an internet calling app on your smartphone—such as Google Voice—to create an entirely separate phone number you can use solely for the purpose of making patient calls.
But at the end of the day let’s face it, with today’s technology if someone really wants to find you and your phone number, there’s no stopping them anyways.
Which patients do you call back?
I would recommend calling discharged patients, and certainly any patient you are concerned about for any reason. Also consider calling the ones who seemed less than pleased with their visit upon leaving—you might be surprised how easy it is to accomplish service recovery just by making the call.
How about patients with interesting problems, or the ones you couldn’t quite figure out and the diagnosis may become clearer with time? Absolutely! Potential liability patients? Yes. Patients who may be non-compliant? Definitely. And of course the patients you enjoyed talking to or visiting with, but just did not have enough time to spend with them. All of these scenarios present a great opportunity to connect with the patient during a follow up call.
What’s the best follow up call process? A piece of paper with names and numbers? An electronic report?
Make sure you engage with your facility compliance department while developing this process. Personally, I keep the names and numbers in a password protected file on my smart phone and discard after use.
It is also imperative that you work with your hospital’s registration department to gain accurate patient contact information. After you start this process, it is likely you will quickly realize your registration department does not get accurate phone numbers from all patients. Stressing the importance of this practice can help improve the success of the patient call back program.
Do you record all the calls in the medical record?
Calls should be recorded in the medical record if specific medical advice or a change in therapy was given over the phone.
What do you say over the phone?
Develop some scripting that fits you, your personality, and your approach to patient care. Start with the basics: “Is now a good time to talk?” “How are you feeling?” “Thank you for allowing me to care for you.”
What if someone other than the patient answers the phone?
My recommendation is to not make call backs to anyone who would not necessarily want others to know that they were in the ED, should someone else happen to answer the phone (i.e. abuse cases, domestic violence, STDs, early pregnancy, etc.). Do not leave messages with anyone other than your patient. If your patient is not available to take the call, just simply say you will call back when the patient is likely to be available. Do not introduce yourself as your patient’s physician until you are certain the patient is available to take the call.
How do patients typically respond to these calls?
Surprised, really. “Wow! This doctor cares enough to call me?!” Another great aspect of follow up calls is that you may discover new information that is important for you or your patient. It’s an opportunity to explain and reinforce, and patients appreciate that.
The phone call is also another chance to do service recovery on a difficult situation. My personal experience has been that the patient is so elated their physician called to check on them that they forget about the problem they had and just thank me for the call.
In conclusion, our ACEP President, Jay Kaplan, MD, FACEP, has said for years that, “Discharge follow up phone calls improve patient care, patient satisfaction, and physician and nurse satisfaction.” When I was inexperienced in making the calls, I was skeptical at first and it took me a while to start the process. However, today I can say that I enthusiastically agree, having experienced the benefits myself firsthand. Since implementing the patient call back program, I have seen improved patient satisfaction scores as well as improved physician morale in the partnering hospital programs I oversee as a Regional Medical Director.
If you are not making any follow up calls currently, I would highly recommend you consider doing so. Again, you will love hearing the positive feedback and appreciation from your patients. And as we are all aware, patient satisfaction is crucial to the success of the emergency department and may soon be tied to reimbursement. A patient call back program is a very valuable tool for us as emergency physicians to support this initiative.
Try it, you will like it!
As always, please feel free to comment below to discuss your own experiences or ask any questions.
Donald Brock, DO, FACEP, earned his Doctor of Osteopathic Medicine degree from the Chicago College of Osteopathic Medicine in 1991. The board certified emergency medicine physician went on to complete an internship and residency at Pontiac Osteopathic Hospital. In addition to his current role serving as Regional Medical Director within IMM’s Midwest Region, Dr. Brock is the acting departmental Medical Director of Promedica Monroe Regional Hospital in Monroe, MI, where he also serves as a member of the emergency medicine residency program core faculty.
Prior to joining the IMM team, Dr. Brock previously served as a Regional Medical Director for NES Healthcare and as a departmental Medical Director at Mercy Memorial Hospital in Monroe, MI. Previous positions held include Chief Medical Officer of EROne in Livonia, MI, and Chairman of Emergency Services of Oakwood Healthcare in Dearborn, MI.
Throughout his more than twenty years of practice in the field of emergency medicine, Dr. Brock has remained involved in emergency department service operations on a national level; his specific special interests include both ED operations and customer service. In addition to his professional and clinical positions at IMM, Dr. Brock is a member of the Certifying Board of Emergency Medicine and a Medical Board Examiner.