Budgeting RN Callbacks

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An inpatient nursing director drafted a design plan for post-hospitalization callbacks as an extension of her unit's patient care. Her model required 1.5 FTEs at a cost of $100,000 annually to reach the 200 patients discharged each week. The proposal was dismissed by the budget committee.

Nonplussed, the director came up with a brilliant solution. She realized that, of the nearly one thousand nurses within the system, a few would be on Worker’s Compensation for work-related orthopedic injuries. During the time physical limitations prevented regular floor work, the hospital was contractually obligated to pay 2/3 of salaries. Two prime candidates were thrilled to have an opportunity to stay clinically active.

After approval by HR, the nurses began administering a 9-question safety assessment to freshly discharged patient’s well being as well as understanding of the diagnosis and after care plan. The new callback nurses quickly became wellness and compliance coaches. Since the questions included nothing about patient satisfaction, the hospital compliance officer agreed that it was in accordance with HCAHPS rules.

During the first quarter of operation, the callback nurses accumulated many examples of making a difference. One post-op hysterectomy patient developed sudden dyspnea. She was persuaded to return to the ER and promptly diagnosed with a large, potentially-deadly, saddle pulmonary embolus requiring thrombolysis. All patients were reminded of the importance of filling prescriptions and following the discharge plan. The patients always appreciated the offer of help in coordinating follow-up testing and appointments. In summary, within a few months, the program saved a life, dropped the 30-day readmission rate, and increased HCAHPS results to an all time high.

While the nurse champion received well-deserved credit for bringing her vision to a healthy reality, research suggests that those outcomes were predictable.*

*http://www.clevelandclinicmeded.com/live/courses/2011/quality11/abstracts/22-Quality-Summit-5-13-2011.pdf.