Children's National Hospital uses robocalls to curb readmissions

Leaders at Children’s National Hospital in Washington, D.C., know that calling patients post-discharge goes a long way toward avoiding a preventable readmission. It’s a tactic that’s been supported by research over the years.

But leaders were  also aware that such efforts often struggle to reach a critical mass. Case managers were only reaching about 5% of parents whose children were discharged.

“It was labor-intensive and person-dependent,” said Kathy Rigney, director of clinical resource management at Children’s National. “Just making the outreach calls was so time-consuming and we really didn’t reach a lot of people. What was evident was when we did reach people, we were able to make a difference.”

There are financial incentives to focus on readmissions, Rigney added. Although children’s hospitals are excluded from the CMS’ 30-day readmissions penalty program, commercial payers have jumped on board, refusing to pay for readmissions for certain conditions within three, five, seven or 30 days of discharge, she said.

Looking for a way to increase its phone calls post-discharge, Children’s National in 2016 began exploring the use of robocalls. Rigney said over the years she came across hospitals that had tried it but didn’t continue the practice long-term because funding ran out. Using $10,000 in donated funds, Children’s National was able to begin a pilot initiative in March with NRC Health, a Lincoln, Neb.-based company.

Children’s National uses a standard set of questions from the company, which allows it to benchmark their results against other NRC Health customers, Rigney said. NRC has roughly 250 hospital clients using its platform, said TJ Ehlers, director of the company.

The pilot began in one 50-bed inpatient hospitalist unit. A key concern Children’s National had to consider was the barrage of robocalls people already get. To address that, nurses told parents during discharge planning discussions to expect an automated call from the hospital around 11 a.m. the following day. Parents are encouraged to answer the call, framing it as an opportunity for the hospital to know how the child is doing and to hear about their experience at the hospital.

During the pilot, which lasted six months, all parents who spoke English or Spanish with children discharged from the 50-bed unit received the call. The electronic health record signaled if the call should be in Spanish. For parents who speak other languages, the global health services division at Children’s National called patients personally, said Elizabeth Bartlett, project coordinator, revenue cycle and case management.

When parents pick up the phone, they are asked to confirm they are the parent or guardian of the child. If they say yes, an introduction from Martha Parra, vice president of clinical support services at Children’s National, lets the parents know they’d like to ask questions about how their child is doing since discharge. The parents are asked eight questions, including if they have questions about the discharge instructions, the child’s medications and follow-up appointments.

If a parent answers yes to any of the questions, an alert is triggered, and the parent is informed that someone from Children’s National will contact them within one business day.

Case managers are given a list every day of parents who need to be called back and they’ve been trained to help patients with most questions. If a nurse or physician needs to get involved, case managers are able to escalate the call to them. 

About 50% of parents answered the call during the pilot. The readmission rate for those patients was 3.2% versus 5.4% for children whose parents did not answer. 

“We are not ready to say the robocalls caused the decreased readmissions because there are other factors” at play, Bartlett said. For instance, a less engaged family is more likely to experience a readmission whereas parents who took the time to answer the robocall are likely more involved in their child’s care in general, she said. 

Children’s National has since expanded the robocalls to all inpatient units and will continue to monitor their impact on readmission rates.