Don't Come Back, We'll Call You: Do Low Grade Solid Organ Injuries Need an In-Person Follow Up Visit?
Tracey Sutherland, cPNP; David Mooney, MD
Boston Children's Hospital, Boston, MA
Background: Children with low grade solid organ injuries infrequently suffer complications after hospital discharge. Given this and the difficulty families have in taking off work to travel to a patient visit, we developed and evaluated a phone follow-up effort for children with low grade solid organ injuries.
Method: In May, 2014 we initiated a phone call follow-up by Trauma Nurse Practitioners for children with isolated grade 1 and 2 solid organ injuries at the end point of their activity restrictions, instead of an office visit. We identified in our Trauma Registry all children with a grade 1 or 2 liver or spleen injury starting in May, 2014. All post-discharge complications, readmissions, Emergency Department visits and other information obtained on the visits and phone calls were reviewed.
Results: 53 patients were admitted with grade 1 or 2 liver or spleen injuries. Twelve children suffered multiple injuries and were excluded and seen in Trauma Clinic follow-up. Of the remaining 41 patients 9 were seen in the Trauma Clinic secondary to parental desire or miscommunication with residents covering trauma patients on weekends regarding the new policy. 32 patients had only telephone follow up. No patient was found to have a post-discharge complication, whether seen in Clinic or contacted by telephone.
Conclusion: Telephone follow up is adequate for children with isolated low grade solid organ injuries. This practice saves families from the inconvenience and expense of an unnecessary visit and will become more necessary if health care financing converts to an Accountable Care model.
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