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The Value of Adding a Verbal Report to Written Handoffs on Early Readmission Following Prolonged Respiratory Failure

Dean R. Hess, PhD, RRT, FCCP; Arthur Tokarczyk, MD; Mary O’Malley, RN; Susan Gavaghan, RN; Judith Sullivan, RN; Ulrich Schmidt, MD, PhD, FCCP
Author and Funding Information

From the Department of Respiratory Care (Dr Hess), Clinical Case Management Unit (Ms O’Malley), Case Management Department, Department of Nursing (Mss Gavaghan and Sullivan), and Department of Anesthesia and Critical Care (Dr Schmidt), Massachusetts General Hospital, Boston, MA; Harvard Medical School (Drs Hess and Schmidt), Boston, MA; Department of Anesthesiology (Dr Tokarczyk), NorthShore University Health System, Evanston, IL; andPritzker School of Medicine (Dr Tokarczyk), University of Chicago, Chicago, IL.

Correspondence to: Dean R. Hess, PhD, RRT, FCCP, Massachusetts General Hospital, Respiratory Care Services, 55 Fruit St, Ellison 401, Boston, MA 02114; e-mail: dhess@partners.org


For editorial comment see page 1292

Funding/Support: The study was conducted at Massachusetts General Hospital using departmental funding.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;138(6):1475-1479. doi:10.1378/chest.09-2140
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Patients who survive the acute phase of respiratory failure often are transferred to units with specialized expertise. These patients have a high risk of being readmitted to the acute care hospital. We conducted this study to determine whether supplementing a written report with a verbal telephone report reduces readmission rates within the first 72 h after discharge and decreases hospital costs. The study design was observational with a historical control group that included patients admitted to our respiratory acute care unit between November 2003 and October 2005. In November 2005, we implemented a strategy in which a written report at discharge was supplemented with a telephone report by the physician or nurse practitioner, nurse, and respiratory therapist. The intervention group began in November 2005 and continued through October 2007. The primary end point was readmission to Massachusetts General Hospital within 72 h of discharge. We also determined the cost related to readmission. The study included 362 patients. The OR for readmission if the handoff included a verbal report was 0.42 (95% CI, 0.17-1.04). The total hospital cost was significantly lower in the group where verbal report was used ($111,723 vs $148,574; P = .002). Supplementing a written report with a verbal telephone report was associated with a significant reduction in cost and an average savings of ∼ $184,000 for every 100 patients discharged, representing added value in delivered care.

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