What is the plan for primary care follow-up after an Emergency Department (ED) visit?

From the Guidelines

After an Emergency Department (ED) visit, patients should schedule a follow-up appointment with their primary care provider within 1-7 days, depending on the severity of their condition, as recommended by recent guidelines 1. For serious conditions like chest pain, breathing difficulties, or post-hospitalization care, follow-up should occur within 1-3 days. For less urgent issues, follow-up within 5-7 days is appropriate. Patients should bring their ED discharge paperwork, medication list, and any new prescriptions to this appointment. They should be prepared to discuss their ED diagnosis, any tests performed, medications prescribed, and any ongoing symptoms. This prompt follow-up is crucial because it ensures continuity of care, allows for medication adjustments if needed, provides an opportunity to review test results that weren't available during the ED visit, and helps prevent return ED visits. If patients don't have a primary care provider, they should ask the ED for recommendations or contact their insurance company for in-network options. Many EDs now offer assistance with scheduling these follow-up appointments before discharge to improve care transitions, as suggested by studies on care transitions and follow-up care 1. Some studies also emphasize the importance of follow-up care in specific conditions, such as acute heart failure, where early follow-up can help reduce readmission rates and improve patient outcomes 1. Overall, timely follow-up care is essential for ensuring the best possible outcomes for patients after an ED visit.

Some key points to consider in the follow-up appointment include:

• Reviewing the ED diagnosis and any test results
• Discussing ongoing symptoms and any changes in condition
• Adjusting medications as needed
• Providing education on self-care and management of the condition
• Coordinating further testing or specialty care if needed
• Ensuring continuity of care and preventing gaps in treatment.

By prioritizing follow-up care and ensuring a smooth transition from the ED to primary care, healthcare providers can help improve patient outcomes, reduce readmissions, and enhance the overall quality of care.

From the Research

Primary Care Follow-up Plan

To form a plan for primary care follow-up after an Emergency Department (ED) visit, several factors should be considered. The plan should aim to increase coordination of care, provide education about chronic conditions, and reinforce discharge instructions.

• Follow-up Visits: Studies have shown that follow-up visits with primary care providers after ED discharge can increase coordination of care 2. A study found that primary care follow-ups after ED discharges increased from 38% to 71% over 10 months with a new nurse-led workflow.
• Patient Education: Nurses can provide education about chronic conditions and reinforce discharge instructions during follow-up visits 2. This can help patients understand their conditions and manage their symptoms.
• Return Visits: Return visits to EDs can be an indicator of potential need for quality improvement 3. A study found that most repeat ED visits resulting in hospitalization do not represent medical errors, but rather the progression of illness.
• Patient Perspectives: Patients value outcomes of ED care that center around understanding the cause and expected trajectory of their symptoms, reassurance, symptom relief, and having a plan to manage their symptoms 4. These themes should be considered when developing a primary care follow-up plan.
• Direct Notification: Direct notification of laboratory and radiology results to patients using the Internet can serve as a safety net, reducing the likelihood of abnormal results being missed 5. However, emergency physicians' concerns about patient anxiety, confusion, and lack of expertise to interpret results need to be addressed.

Key Considerations

When forming a primary care follow-up plan, the following key considerations should be taken into account:

• The majority of return visits to EDs are for follow-up services 6
• Primary care follow-ups after ED discharges can increase coordination of care 2
• Patients value understanding the cause and expected trajectory of their symptoms, reassurance, symptom relief, and having a plan to manage their symptoms 4
• Direct notification of laboratory and radiology results to patients can serve as a safety net, but emergency physicians' concerns need to be addressed 5