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Original Investigation
September 4, 2018

Effects of a 1-Time Nurse-Led Telephone Call After Pediatric Discharge: The H2O II Randomized Clinical Trial

Author Affiliations
  • 1Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
  • 2James M. Anderson Center for Health System Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
  • 3Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
  • 4Department of Patient Services, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
  • 5College of Nursing, Ohio State University, Columbus
  • 6Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
  • 7Northeast Node of the National Drug Abuse Clinical Trials Network, Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire
JAMA Pediatr. 2018;172(9):e181482. doi:10.1001/jamapediatrics.2018.1482
Key Points

Question  Does a telephone call from a nurse after routine pediatric discharge prevent use of urgent health care services?

Findings  In this randomized clinical trial of 966 children discharged from a general medicine hospital service, children randomized to the intervention had similar reutilization rates for urgent health care services compared with children randomized to standard discharge.

Meaning  Telephone calls from a nurse after pediatric discharge do not result in decreased reutilization rates for urgent health care services.


Importance  Families often struggle after discharge of a child from the hospital. Postdischarge challenges can lead to increased use of urgent health care services.

Objective  To determine whether a single nurse-led telephone call after pediatric discharge decreased the 30-day reutilization rate for urgent care services and enhanced overall transition success.

Design, Setting, and Participants  This Hospital-to-Home Outcomes (H2O) randomized clinical trial included 966 children and adolescents younger than 18 years (hereinafter referred to as children) admitted to general medicine services at a free-standing tertiary care children’s hospital from May 11 through October 31, 2016. Data were analyzed as intention to treat and per protocol.

Interventions  A postdischarge telephone call within 4 days of discharge compared with standard discharge.

Main Outcomes and Measures  The primary outcome was the 30-day reutilization rate for urgent health care services (ie, unplanned readmission, emergency department visit, or urgent care visit). Secondary outcomes included additional utilization measures, as well as parent coping, return to normalcy, and understanding of clinical warning signs measured at 14 days.

Results  A total of 966 children were enrolled and randomized (52.3% boys; median age [interquartile range], 2.4 years [0.5-7.8 years]). Of 483 children randomized to the intervention, the nurse telephone call was completed for 442 (91.5%). Children in the intervention and control arms had similar reutilization rates for 30-day urgent health care services (intervention group, 77 [15.9%]; control group, 63 [13.1%]; P = .21). Parents of children in the intervention group recalled more clinical warning signs at 14 days (mean, 1.8 [95% CI, 1.7-2.0] in the intervention group; 1.5 [95% CI, 1.4-1.6] in the control group; ratio of intervention to control, 1.2 [95% CI, 1.1-1.3]).

Conclusions and Relevance  Although postdischarge nurse contact did not decrease the reutilization rate of postdischarge urgent health care services, this method shows promise to bolster postdischarge education.

Trial Registration  ClinicalTrials.gov Identifier: NCT02081846