Three interventions were already placed and performed in the study hospital ED before the initiation of this study. Therefore, we aim to investigate the outcomes of providing step-wise interventions and further optimize such interventions for ED discharge failure prevention. At present, we are uncertain of any benefit brought from these step-wise interventions and unable to determine the optimal intervention that eventually could increase clinic compliance and decrease ED discharge failures. Therefore, the study hospital follows a common pragmatic practice by implementing step-wise interventions. However, commonly, it is challenging to assign dedicated PCPs without insurance coverage or to set up regular PCP visits without dedicated PCPs. The overarching goal was to implement an effective package of interventions to maximize PCP clinic compliance and minimize ED discharge failures. In addition, a telephone call to remind the patient of their appointment was made prior to the patient’s PCP visit. Once patients qualified for hospital-based charity insurance, a dedicated PCP was assigned to each patient, and a formal follow-up PCP visit was arranged. If they were able to qualify, steps initiating the charity insurance coverage for patients were begun. Upon patient discharge, case managers assessed the patient’s qualification for hospital-based charity insurance. The study hospital ED initiated these common interventions together in a step-wise manner. This variation is due to different interventions rendered in different studies without use of standard outcome measurements, thereby requiring further external validation. However, the value of these interventions is varied when analyzing the literature. We assumed that increased patient clinic follow-up compliance would eventually decrease inappropriate ED utilization and/or returns. Realizing these potential contributing factors, different combinations of the following interventions were implemented to improve follow up compliance: providing charity insurance, assigning a dedicated PCP, and providing a phone call or text message to remind patients of post-ED discharge clinic appointments. Patients without a dedicated PCP are also reported to have relatively poor follow-up visit compliance. Patients who lack insurance are reported to have relatively poor PCP follow-up compliance. Patients with high psychosocial risks or homeless patients might have lower PCP follow-up rates. Many factors could affect patient follow-up after ED discharge. ![]() Among all current interventions, having health insurance and having a follow-up appointment set prior to a patient’s ED departure are considered the most effective for patient follow-up compliance. Other studies on a dedicated PCP’s office contacting patients after ED discharge showed increased PCP visits but not decreased ED discharge failures. Studies on utilizing telephone reminders for patient follow-up appointments showed different call success rates with variable outcomes on ED discharge failures. In recently years, numerous studies have been published on transition care from ED to PCP. ![]() Nearly one-third of ED patients who do follow up with their primary care physician (PCP) or specialist still have short-term ED returns, and many ED discharged patients may never follow-up with PCP clinics at all. However, ED discharge failures are frequent. ED discharge failure is defined as patients discharged from ED that either have no primary care physician (PCP) clinic follow-up or that return to the ED inappropriately prior to their clinic visits. Timely post-ED discharge follow-up has been shown to improve patient-centered care for disease prevention, monitoring, and management. Traditional practice recommends arranging timely clinic follow-up for patients who are discharged from the Emergency Department (ED).
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