Whatever happened to Mr Smith?

Have you been wondering what happened to that patient of yours that crashed and was sent to ICU yesterday?

What about Mr Smith, that post-op patient that you got on so well with and was discharged home whilst you were on days off?

And I know you have been thinking about Mrs Gruber, that really difficult, demanding, often obnoxious patient that was transferred to another ward last week.

We all think about patients that move on from our care. Sometimes we think about certain individual patients…a lot (if only the public knew).

It might be a professional interest in how they responded to treatment, or it might be because you have made a connection with that particular person. Often, there are many staff wondering about how they are doing now.

There is something you can do about this……

The Chase-up team.

Form up a group of interested and motivated colleagues to start a chase-up board or folder for your unit.
The board would be located in your break room or other non-public area.

When a nurse is interested on what happened to a particular patient after they have left the ward or unit they can write the details (I would suggest only the patients medical record number and DOB be used) and dates in a note book specifically for this purpose.
The chase-up team will then follow up on each request.

Sometimes (as in the case of critically unwell patients) this may be done 24 or 48 hours later.

Other times a follow up could occur on a patient that has moved on from your unit weeks or months ago (patients that are transferred to re-hab for example).

A short de-identified summary about the patients presentation followed by an update on their progress to date can then be posted on a board or in a folder for interested staff to read.
This provides important feedback to the staff on the outcomes of the care they delivered both at an educational and a personal level.

Follow up is especially useful in critical care areas where there can be a high turn over of patients and we often are left wondering ‘I wonder whatever happened to…..’
Once the information has been posted for a while the chase-up team ensures that it is appropriately destroyed.

Issues of confidentiality?

Many might raise issues of confidentiality here. But I see this sort of feedback loop as being an important (if not essential) part of improving both the quality of our care delivery and our work satisfaction.
Why should there suddenly be a cease in clinical information from the team that has been caring for this patient just because they have moved to a different geographical location within the hospital?

It has been my experience that many staff will informally acquire follow up information anyway if they really want to know how their patients are doing.

This way it would only be the designated chase-up team going to the next point of care to retrieve information, and this information would be de-identified. Perhaps patients could sign a consent for this information to be shared.

Chase-up after discharge.

So far I have been talking about chasing up information about patients that remain in the hospital and have been transferred to other areas.
I think it would also be a fantastic idea for the chase-up team to follow up on patients that have been discharged from hospital.

This would involve a short scripted telephone call explaining that the staff have been thinking about them and that we would just like to ‘check-in’ with them and see how they are have been managing since discharge. You would also ask permission to place this de-identified information in your chase-up book.
However, this should probably not be undertaken without the blessings of your unit manager (and it may need to be approved from higher up).

There would also need to be clear guidelines for managing and referring complaints and issues that may be raised during these calls.
Having been involved in follow up calls (for the purposes of project data collection) I can report that these sort of follow up calls are generally very much appreciated by the people you talk to.

Even when the person does have issues or even complaints they usually appreciate that you have given the opportunity to voice them. They can then be referred on to your hospitals consumer engagement team or other appropriate resources.

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