QS101 - Improved Transition of Care With Phone-Based Management Algorithm: A Prospective Randomized Controlled Trial

Sunday, May 11, 2025

8:10 AM – 8:13 AM PT

Location: Room 9, Upper Level

Quick Shot Presenter(s)

zt

zheng hong tan, PhD

Medical Student
The Ohio State University College of Medicine
Columbus, Ohio, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Author(s)

SL

Shan Lansing, MD

Resident Physician
Oregon Health & Science University
Portland, Oregon, United States

Disclosure information not submitted.
AF

Alicia Finn, MSN, APRN, FNP-BC

Nurse Practitioner
The Ohio State University
Columbus, Ohio, United States

Disclosure information not submitted.
SL

Scott Lake, APRN-CNP

Nurse Practitioner
The Ohio State University Wexner Medical Ceneter
Columbus, Ohio, United States

Disclosure information not submitted.
AF

Amanda M. Finnicum, MSN, APRN-CNP, AGACNP-BC

Advanced Practice Provider
The Ohio State University
Columbus, Ohio, United States

Disclosure information not submitted.
AG

Alessandra Gasior, DO

Associate Professor
The Ohio State University
Columbus, Ohio, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
AH

Alan E. Harzman, MD

Professor
The Ohio State University
Columbus, Ohio, United States

Disclosure information not submitted.
Amber L. Traugott, MD (she/her/hers)

Associate Professor
The Ohio State University
The Ohio State University Wexner Medical Center
Columbus, Ohio, United States

Disclosure information not submitted.
Matthew F. Kalady, MD

Professor, Division Director,
The Ohio State University Wexner Medical Center and James Cancer Center
Ohio State University
Columbus, Ohio, United States

Disclosure information not submitted.
Emily Huang, MD

Assistant Professor
The Ohio State University
Columbus, Ohio, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Senior Author(s)

Syed Husain, MD

Professor
The Ohio State University
Ohio State University
Columbus, Ohio, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.

zheng hong tan, PhD: This individual has no financial relationships with ineligible companies.

Alessandra Gasior, DO: This individual has no financial relationships with ineligible companies.

Emily Huang, MD: This individual has no financial relationships with ineligible companies.

Syed Husain, MD: This individual has no financial relationships with ineligible companies.

Image or Table (Do Not add text here):

Purpose/Background: Colorectal surgery patients have a high rate of hospital readmission due to increased risk of infection, anastomotic leakage, bleeding, or thromboembolic events. Immediately upon discharge, patients and their caregivers are expected to manage the recovery period. Although the patient’s physical condition may qualify them for home discharge, studies have shown that patients and caregivers are routinely under-prepared to assess and manage their condition after leaving the hospital. Transition of care has been identified as a specially vulnerable period for post-operative patients as often there is minimal contact between the healthcare team and the patient during the hiatus. This study examines the impact of a targeted post-operative phone call during the transition of care after surgery.

Methods/Interventions: This is a prospective randomized controlled trial at a tertiary academic center including 480 patients undergoing elective colorectal procedures. Patients were randomized into 2 groups: The control group was discharged with standard follow-up instructions and a clinic follow-up in 2-3 weeks. The Intervention arm received a phone call 3 days post-discharge in addition to the standard instructions and follow-up clinic visits. The scripted phone call assessed for most frequent indications for readmission after colorectal surgery. Patients were advised to maintain the appointment as scheduled, expedite their clinic visit within 48 hours, or go to the Emergency Department based on acuity assessed using a care algorithm (Fig 1). All calculations were performed using an intention-to-treat model.

Results/Outcomes: Of the 480 patients enrolled in this study, 227 patients were randomized to the control arm and 253 patients to the intervention arm. The cohorts were similar in terms of demographic characteristics (Fig 2). Of the 253 patients in the intervention arm, 113 (44.6%) were successfully contacted and received their post-op phone call. Patients in the intervention arm had a 31% reduction in readmissions (p=0.09). 23% of the patients in intervention arm were identified to require an expedited visit. Number needed to treat was 19.62 phone calls to prevent one readmission.

Conclusion/Discussion: This prospective randomized controlled trial demonstrates that a targeted post-operative phone call within 3 days of discharge significantly improves the transition of care for patients undergoing colorectal surgery. Despite a moderate success rate in contacting patients, the intervention group experienced a notable reduction in hospital readmissions, highlighting the value of proactive outreach during the vulnerable recovery period. Importantly, early identification of patients requiring expedited follow-up further underscores the role of structured post-discharge communication in enhancing patient outcomes and reducing healthcare resource utilization.