nfralick
Wed, 12/10/2025 - 15:39
Edited Text
Reducing Hospital
Readmissions in
Postpartum Patients
by Implementing a
Discharge Phone Call
Program: A Program
Evaluation
DNP Project
Jacqueline Drahos, MSN, RN, CPHQ
Doctor of Nursing Practice Candidate
• In the United States, there are
approximately four million births
annually, the most common indication for
hospitalization, costing around $19.1
billion (Wen et al., 2020)
• The first forty-two days after childbirth
are known as postpartum and are
associated with increased risks of
maternal and neonatal morbidity and
mortality
• More than half of maternal deaths in the
United States occur during the
postpartum period, with 40% occurring
between day one through forty-one
(Girsen et al., 2022)
• 40% of women fail to attend the
recommended postpartum visit
(Lewey et al., 2020)
• Hospital readmission occurs when
a patient returns to an acute care
hospital within a specified
timeframe (The Centers for
Medicare and Medicaid Services,
2023)
• Hospital readmissions are
considered a key quality measure
(Rammohan et al., 2023)
• Early recognition and interventions
have proven to improve overall
morbidity and mortality for
postpartum women
Hospital Readmission
Reduction Program (HRRP)
In 2012, CMS began penalizing hospitals for high
readmission rates in conditions like AMI, COPD, HF,
pneumonia, CABG, and THA/TKA (The Centers for
Medicare and Medicaid Services, 2023)
No standardized CMS metric for postpartum
readmissions currently exists
Concerns remain for using readmission reduction as
a universal quality metric due to lack of risk
adjustment and unintended harm in vulnerable
populations
• High readmission rates observed in the postpartum unit
Problem
Statement
• Lack of early follow-up leads to missed intervention
opportunities
• Evidence gap: Does a postpartum discharge phone call
within 7 days reduce readmission rates?
PICOT
Question
&
Hypothesis
In postpartum women 18 years and
older (P), how does implementing
discharge phone calls within seven days
(I), compared to the current state of no
discharge phone calls (C), decrease allcause readmission rates (O) over six
months (T)?
• Null hypothesis H₀: There will be no
difference in the readmission rate
between patients who received
discharge phone calls and those who
did not.
• Positive hypothesis H₁: There will
be a statistically significant difference
in readmission rates between patients
who received a discharge phone call
and those who did not.
(Justdone.com, n.d.)
• Risk Factors
• Who should make D/C phone calls
• Determining Factors
• Should postpartum readmission be a
• Educational Needs
quality metric
Gap Analysis: Obstetrical Office Survey to
Assess Discharge Phone Calls
OB Office
Do you have a
post-delivery
Call Timing
call process in
place?
1
Yes
2 weeks
2
3
No
No
N/A
N/A
Start Discharge
Documentation
Call Program?
Postpartum
telephone
encounter
N/A
N/A
3-4 Day
Follow-up
calls?
Care Connect? Additional Notes
Maybe
Yes
Yes
Maybe
Yes
Yes
Yes
Yes
Yes
4
No
N/A
N/A
Maybe
Yes
Yes
5
No
N/A
N/A
Yes
No
Yes
6
No
N/A
N/A
Maybe
Yes
Yes
7
No
N/A
N/A
Maybe
No
Yes
8
No
N/A
N/A
Maybe
No
Yes
9
No
N/A
N/A
No
No
No
No brochures,
info in initial OB
book
Phone follow-up
possible, not inoffice
MyChart
communication
preferred
Previous attempts
were inconsistent
due to staffing
Consulting
practice only, no
deliveries
Gap Analysis: Birthing Hospitals Discharge
Phone Call Survey
Birthing
Hospital
Discharge
Calls?
Who Makes
Calls?
Standardized
Template?
Call Timing
(Days PostDischarge)
Number of
Attempts
EPIC
Documentation
?
Barriers (if
applicable)
1
Yes
Lactation
Consultant
Yes
2-3
1
No
N/A
2
Not
Consistently
IBCLC
No
N/A
1
No
IBCLC struggles to
keep up
3
Yes
Unit Nurses
Yes
3-4
2
No
N/A
4
Yes
Unit Nurses
Yes
N/A
Yes (Telephone
encounter)
N/A
5
No
N/A
N/A
N/A
N/A
Completed from
Postpartum
N/A
Methodology
• Quantitative
• Quasi-experimental
• Pre-Post design
• Descriptive statistics
• Independent variables that will cause
the change are discharge phone calls
• Dependent variable will be the rate of
hospital readmissions during the
postpartum period of 30 days
Statistical Analysis
• Independent T-Test
• Used to determine if there is a
significant difference between
the means of two groups and
how they are related
• Fischer’s Exact Test
• Used to calculate the
probability between the
variables
Setting and
Study
Population
Lewin's Change Theory Application
Unfreezing: Recognized high postpartum
readmission rates; leadership
acknowledged need for change
Changing: Implemented discharge phone
calls; integrated into workflow; data
tracked with quality team
Refreezing: New practice accepted and
embedded in unit culture; standard
established
Plan-Do-Study-Act Cycle
• PDSA used as a continuous
improvement model to implement and
refine discharge phone calls for
postpartum patients
• Plan: Identified high readmission rates;
gathered baseline data via surveys and
chart reviews
• Do: Tested discharge phone call
intervention; collected data during
implementation
• Study: Analyzed results to evaluate
effectiveness and compared outcomes
• Act: Adjusted and implemented best
practices based on findings
(Institute of Medicine, n.d.)
The cycle was iterative, allowing ongoing
refinement to improve postpartum care
and reduce readmissions
Ethical Consideration
• No anticipated ethical issues
• Informed consent was not needed
• Administration approval obtained for
the postpartum unit to conduct the QI
project
• Institutional review board approval
was obtained from the university and
the healthcare organization as QI
• Collaborative Institutional Training
Initiative training completed
Interventions # 1
• The postpartum discharging
nurse completed the top of the
Discharge Phone Call form
upon discharge
• Patient name
• Mode of delivery
• Feeding type
• Any HTN, gDM,
depression, or anxiety
• Phone number verification
• Notification of a phone call
within seven days
Interventions # 2
• The assistant nurse manager called
the patient within 7 days of index
admission
• Questions completed
• Patient experience
• Educational booklet utilization
• Follow-up appointments
• Mode of feeding
• S/SX of infection, elevated
B/P, anxiety, or depression
• Attempted to contact the patient
twice and documented
Survey Results for Mode of Delivery,
Feeding Type & Pain Control
Mode of
Delivery
500
450
400
350
300
250
200
150
100
50
0
Feeding Type
Pain Control
Survey Results for Hospital Satisfaction, FollowUp Appointment & Breast-Feeding Concerns
Hospital Satisfaction
500
450
400
350
300
250
200
150
100
50
0
Follow-Up
Appointment
Breast-Feeding
Concerns
Survey Results for Discharge Instruction (D/C)
Questions & S/SX of Infection from C-section
Discharge Instruction
Questions
C-section S/Sx of
Infection
500
450
400
350
300
250
200
150
100
50
0
Yes
No
N/A
Yes
No
N/A/Not
answered
Survey Results for HTN Questions
Monitoring BP
500
450
400
350
300
250
200
150
100
50
0
On BP
Meds
H/A/Visual
Symptoms
F/U Appt
Survey Results for Anxiety/Depression
500
450
400
350
300
250
200
150
100
50
0
Feeling
sad/decreased
activity
Pre-discharge
meds
Follow-up for
medication
Discharge Phone Call Connection
March through August 2024
350
20%
18%
300
16%
250
14%
12%
200
10%
150
8%
6%
100
4%
50
2%
0
0%
March
April
May
June
July
Total Number of Patients Who Received a Discharge Phone Call
Total Number of Discharged Patient
Percentage Connected
Linear (Total Number of Patients Who Received a Discharge Phone Call )
August
Cumulative Variable Data with Statistical Test
Results and Significance
p-value
Cohen’s d
Effect Size
Interpretation
Statistical
Significance?
Variables
Statistical Test
Age
Independent Sample T-age Effect
Size
test
0.829
-0.0509 Negligible
No
BMI
Independent Sample T-age Effect
Size
test
0.041
-0.487 Moderate
Yes
LOS
Independent Sample T-age Effect
Size
test
0.006
0.667 Moderate
Yes
Days Between
Independent Sample T-age Effect
Size
test
0.754
0.0738 Negligible
No
Race
Fisher's Exact Test
1
N/A
N/A
No
Ethnicity
Fisher's Exact Test
0.469
N/A
N/A
No
Social Determinants of Health
Fisher's Exact Test
0.869
N/A
N/A
No
Insurance Type
Fisher's Exact Test
0.017
N/A
N/A
Yes
Mode of Delivery
Fisher's Exact Test
0.469
N/A
N/A
No
Primary Care Physician at Index Admission
Fisher's Exact Test
0.015
N/A
N/A
Discharge Appointment Made on Index Admission
Fisher's Exact Test
0.555
N/A
N/A
Diagnosis of Gestational Hypertension on Index
Admission
Fisher's Exact Test
0.312
N/A
N/A
Discharge Phone Calls
Fisher's Exact Test
0.001
N/A
N/A
Yes
No
No
Yes
Readmission Rate Comparison March
through August 2023 and 2024
Year
Total Discharges
Readmissions
Readmission
Rate (%)
2023
1854
35
1.89%
2024
1814
38
2.09%
Future Study
Recommendations
Focus on Postpartum Hypertension
Standardized Discharge Planning
Dedicated Discharge Follow-up Team
Targeted Risk-Based Interventions
Technology-Enhanced Follow-up
Consider Seasonal and Volume Variations
Conclusion
• A comprehensive pre-post program evaluation was
conducted using surveys, chart reviews,
descriptive statistics, and statistical testing
• There was a statistically significant association
between receiving a discharge call and reduced
readmission
• The evaluation supports implementing discharge
phone calls within 7 days postpartum as part of
standard care
• To enhance effectiveness, it's recommended to
combine calls with standardized discharge
education and explore additional modes of followup
Overall, timely phone calls post-discharge are a
promising strategy for reducing maternal
readmissions and promoting safe transitions home
References
• Clipground. (2019). Literature review clipart.
https://www.bing.com/search?q=Literature+Review+Clipart+10+free+Cliparts+%7
C+Download+images+on+Clipground+2025&cvid=9894d7c37e444885947a3051c
0c16455&gs_lcrp=EgRlZGdlKgYIABBFGDkyBggAEEUYOTIGCAEQRRg80gE
HNjIxajBqNKgCALACAA&FORM=ANAB01&PC=NMTS
• Centers for Medicare and Medicaid Services. (2023, September 6). Hospital
Readmissions Reduction Program (HRRP).
https://www.cms.gov/medicare/quality/value-based-programs/hospital-readmissions
• Girsen, A. I., Leonard, S. A., Butwick, A. J., Joudi, N., Carmichael, S. L., & Gibbs,
R. S. (2022). Early postpartum readmissions: Identifying risk factors at birth
hospitalization. American Journal of Gynecological (AJOG) Global Reports, 2(4).
• Institute of Healthcare Improvement. (n.d.). How to improve: Model for
improvement. https://www.ihi.org/resources/how-improve-model-improvement
References
• JustDone. (n.d.). Free Literature Review Maker Online.
https://justdone.ai/other/literature-review-maker-onlinefree?utm_source=bing&utm_medium=cpc&utm_campaign=485982430&utm_conten
t=1239150694215853&utm_adset_id=1239150694215853&utm_term=justdone&ut
m_network=o&utm_matchtype=b&msclkid=2dc0184a208a1cd597d07faffa2cf3ba
• Lewey, J., Levine, L. D., Yang, L., Triebwasser, J. E., & Groeneveld, P. W. (2020).
Patterns of postpartum ambulatory care follow-up care among women with
hypertensive disorders of pregnancy. Journal of the American Heart Association,
9(17), e016357.
• Rammohan, R., Joy, M., Magam, S. G., Natt, D., Patel, A., Akande, O., Yost, R. M.,
Bunting, S., Anand, P., & Mustacchia, P. (2023). The path to sustainable healthcare:
Implementing care transition teams to mitigate hospital readmissions and improve
patient outcomes. Cureus, 15(5), e39022.
• Wen, T., Krenitsky, N. M., Clapp, M. A., D'Alton, M. E., Wright, J. D., Attenello, F.,
Mack, W. J., and Friedman, A. M. (2020). Fragmentation of postpartum readmissions
in the United States. American Journal of Obstetrics and Gynecology, 223(2),
252.e1–252.e14.
Readmissions in
Postpartum Patients
by Implementing a
Discharge Phone Call
Program: A Program
Evaluation
DNP Project
Jacqueline Drahos, MSN, RN, CPHQ
Doctor of Nursing Practice Candidate
• In the United States, there are
approximately four million births
annually, the most common indication for
hospitalization, costing around $19.1
billion (Wen et al., 2020)
• The first forty-two days after childbirth
are known as postpartum and are
associated with increased risks of
maternal and neonatal morbidity and
mortality
• More than half of maternal deaths in the
United States occur during the
postpartum period, with 40% occurring
between day one through forty-one
(Girsen et al., 2022)
• 40% of women fail to attend the
recommended postpartum visit
(Lewey et al., 2020)
• Hospital readmission occurs when
a patient returns to an acute care
hospital within a specified
timeframe (The Centers for
Medicare and Medicaid Services,
2023)
• Hospital readmissions are
considered a key quality measure
(Rammohan et al., 2023)
• Early recognition and interventions
have proven to improve overall
morbidity and mortality for
postpartum women
Hospital Readmission
Reduction Program (HRRP)
In 2012, CMS began penalizing hospitals for high
readmission rates in conditions like AMI, COPD, HF,
pneumonia, CABG, and THA/TKA (The Centers for
Medicare and Medicaid Services, 2023)
No standardized CMS metric for postpartum
readmissions currently exists
Concerns remain for using readmission reduction as
a universal quality metric due to lack of risk
adjustment and unintended harm in vulnerable
populations
• High readmission rates observed in the postpartum unit
Problem
Statement
• Lack of early follow-up leads to missed intervention
opportunities
• Evidence gap: Does a postpartum discharge phone call
within 7 days reduce readmission rates?
PICOT
Question
&
Hypothesis
In postpartum women 18 years and
older (P), how does implementing
discharge phone calls within seven days
(I), compared to the current state of no
discharge phone calls (C), decrease allcause readmission rates (O) over six
months (T)?
• Null hypothesis H₀: There will be no
difference in the readmission rate
between patients who received
discharge phone calls and those who
did not.
• Positive hypothesis H₁: There will
be a statistically significant difference
in readmission rates between patients
who received a discharge phone call
and those who did not.
(Justdone.com, n.d.)
• Risk Factors
• Who should make D/C phone calls
• Determining Factors
• Should postpartum readmission be a
• Educational Needs
quality metric
Gap Analysis: Obstetrical Office Survey to
Assess Discharge Phone Calls
OB Office
Do you have a
post-delivery
Call Timing
call process in
place?
1
Yes
2 weeks
2
3
No
No
N/A
N/A
Start Discharge
Documentation
Call Program?
Postpartum
telephone
encounter
N/A
N/A
3-4 Day
Follow-up
calls?
Care Connect? Additional Notes
Maybe
Yes
Yes
Maybe
Yes
Yes
Yes
Yes
Yes
4
No
N/A
N/A
Maybe
Yes
Yes
5
No
N/A
N/A
Yes
No
Yes
6
No
N/A
N/A
Maybe
Yes
Yes
7
No
N/A
N/A
Maybe
No
Yes
8
No
N/A
N/A
Maybe
No
Yes
9
No
N/A
N/A
No
No
No
No brochures,
info in initial OB
book
Phone follow-up
possible, not inoffice
MyChart
communication
preferred
Previous attempts
were inconsistent
due to staffing
Consulting
practice only, no
deliveries
Gap Analysis: Birthing Hospitals Discharge
Phone Call Survey
Birthing
Hospital
Discharge
Calls?
Who Makes
Calls?
Standardized
Template?
Call Timing
(Days PostDischarge)
Number of
Attempts
EPIC
Documentation
?
Barriers (if
applicable)
1
Yes
Lactation
Consultant
Yes
2-3
1
No
N/A
2
Not
Consistently
IBCLC
No
N/A
1
No
IBCLC struggles to
keep up
3
Yes
Unit Nurses
Yes
3-4
2
No
N/A
4
Yes
Unit Nurses
Yes
N/A
Yes (Telephone
encounter)
N/A
5
No
N/A
N/A
N/A
N/A
Completed from
Postpartum
N/A
Methodology
• Quantitative
• Quasi-experimental
• Pre-Post design
• Descriptive statistics
• Independent variables that will cause
the change are discharge phone calls
• Dependent variable will be the rate of
hospital readmissions during the
postpartum period of 30 days
Statistical Analysis
• Independent T-Test
• Used to determine if there is a
significant difference between
the means of two groups and
how they are related
• Fischer’s Exact Test
• Used to calculate the
probability between the
variables
Setting and
Study
Population
Lewin's Change Theory Application
Unfreezing: Recognized high postpartum
readmission rates; leadership
acknowledged need for change
Changing: Implemented discharge phone
calls; integrated into workflow; data
tracked with quality team
Refreezing: New practice accepted and
embedded in unit culture; standard
established
Plan-Do-Study-Act Cycle
• PDSA used as a continuous
improvement model to implement and
refine discharge phone calls for
postpartum patients
• Plan: Identified high readmission rates;
gathered baseline data via surveys and
chart reviews
• Do: Tested discharge phone call
intervention; collected data during
implementation
• Study: Analyzed results to evaluate
effectiveness and compared outcomes
• Act: Adjusted and implemented best
practices based on findings
(Institute of Medicine, n.d.)
The cycle was iterative, allowing ongoing
refinement to improve postpartum care
and reduce readmissions
Ethical Consideration
• No anticipated ethical issues
• Informed consent was not needed
• Administration approval obtained for
the postpartum unit to conduct the QI
project
• Institutional review board approval
was obtained from the university and
the healthcare organization as QI
• Collaborative Institutional Training
Initiative training completed
Interventions # 1
• The postpartum discharging
nurse completed the top of the
Discharge Phone Call form
upon discharge
• Patient name
• Mode of delivery
• Feeding type
• Any HTN, gDM,
depression, or anxiety
• Phone number verification
• Notification of a phone call
within seven days
Interventions # 2
• The assistant nurse manager called
the patient within 7 days of index
admission
• Questions completed
• Patient experience
• Educational booklet utilization
• Follow-up appointments
• Mode of feeding
• S/SX of infection, elevated
B/P, anxiety, or depression
• Attempted to contact the patient
twice and documented
Survey Results for Mode of Delivery,
Feeding Type & Pain Control
Mode of
Delivery
500
450
400
350
300
250
200
150
100
50
0
Feeding Type
Pain Control
Survey Results for Hospital Satisfaction, FollowUp Appointment & Breast-Feeding Concerns
Hospital Satisfaction
500
450
400
350
300
250
200
150
100
50
0
Follow-Up
Appointment
Breast-Feeding
Concerns
Survey Results for Discharge Instruction (D/C)
Questions & S/SX of Infection from C-section
Discharge Instruction
Questions
C-section S/Sx of
Infection
500
450
400
350
300
250
200
150
100
50
0
Yes
No
N/A
Yes
No
N/A/Not
answered
Survey Results for HTN Questions
Monitoring BP
500
450
400
350
300
250
200
150
100
50
0
On BP
Meds
H/A/Visual
Symptoms
F/U Appt
Survey Results for Anxiety/Depression
500
450
400
350
300
250
200
150
100
50
0
Feeling
sad/decreased
activity
Pre-discharge
meds
Follow-up for
medication
Discharge Phone Call Connection
March through August 2024
350
20%
18%
300
16%
250
14%
12%
200
10%
150
8%
6%
100
4%
50
2%
0
0%
March
April
May
June
July
Total Number of Patients Who Received a Discharge Phone Call
Total Number of Discharged Patient
Percentage Connected
Linear (Total Number of Patients Who Received a Discharge Phone Call )
August
Cumulative Variable Data with Statistical Test
Results and Significance
p-value
Cohen’s d
Effect Size
Interpretation
Statistical
Significance?
Variables
Statistical Test
Age
Independent Sample T-age Effect
Size
test
0.829
-0.0509 Negligible
No
BMI
Independent Sample T-age Effect
Size
test
0.041
-0.487 Moderate
Yes
LOS
Independent Sample T-age Effect
Size
test
0.006
0.667 Moderate
Yes
Days Between
Independent Sample T-age Effect
Size
test
0.754
0.0738 Negligible
No
Race
Fisher's Exact Test
1
N/A
N/A
No
Ethnicity
Fisher's Exact Test
0.469
N/A
N/A
No
Social Determinants of Health
Fisher's Exact Test
0.869
N/A
N/A
No
Insurance Type
Fisher's Exact Test
0.017
N/A
N/A
Yes
Mode of Delivery
Fisher's Exact Test
0.469
N/A
N/A
No
Primary Care Physician at Index Admission
Fisher's Exact Test
0.015
N/A
N/A
Discharge Appointment Made on Index Admission
Fisher's Exact Test
0.555
N/A
N/A
Diagnosis of Gestational Hypertension on Index
Admission
Fisher's Exact Test
0.312
N/A
N/A
Discharge Phone Calls
Fisher's Exact Test
0.001
N/A
N/A
Yes
No
No
Yes
Readmission Rate Comparison March
through August 2023 and 2024
Year
Total Discharges
Readmissions
Readmission
Rate (%)
2023
1854
35
1.89%
2024
1814
38
2.09%
Future Study
Recommendations
Focus on Postpartum Hypertension
Standardized Discharge Planning
Dedicated Discharge Follow-up Team
Targeted Risk-Based Interventions
Technology-Enhanced Follow-up
Consider Seasonal and Volume Variations
Conclusion
• A comprehensive pre-post program evaluation was
conducted using surveys, chart reviews,
descriptive statistics, and statistical testing
• There was a statistically significant association
between receiving a discharge call and reduced
readmission
• The evaluation supports implementing discharge
phone calls within 7 days postpartum as part of
standard care
• To enhance effectiveness, it's recommended to
combine calls with standardized discharge
education and explore additional modes of followup
Overall, timely phone calls post-discharge are a
promising strategy for reducing maternal
readmissions and promoting safe transitions home
References
• Clipground. (2019). Literature review clipart.
https://www.bing.com/search?q=Literature+Review+Clipart+10+free+Cliparts+%7
C+Download+images+on+Clipground+2025&cvid=9894d7c37e444885947a3051c
0c16455&gs_lcrp=EgRlZGdlKgYIABBFGDkyBggAEEUYOTIGCAEQRRg80gE
HNjIxajBqNKgCALACAA&FORM=ANAB01&PC=NMTS
• Centers for Medicare and Medicaid Services. (2023, September 6). Hospital
Readmissions Reduction Program (HRRP).
https://www.cms.gov/medicare/quality/value-based-programs/hospital-readmissions
• Girsen, A. I., Leonard, S. A., Butwick, A. J., Joudi, N., Carmichael, S. L., & Gibbs,
R. S. (2022). Early postpartum readmissions: Identifying risk factors at birth
hospitalization. American Journal of Gynecological (AJOG) Global Reports, 2(4).
• Institute of Healthcare Improvement. (n.d.). How to improve: Model for
improvement. https://www.ihi.org/resources/how-improve-model-improvement
References
• JustDone. (n.d.). Free Literature Review Maker Online.
https://justdone.ai/other/literature-review-maker-onlinefree?utm_source=bing&utm_medium=cpc&utm_campaign=485982430&utm_conten
t=1239150694215853&utm_adset_id=1239150694215853&utm_term=justdone&ut
m_network=o&utm_matchtype=b&msclkid=2dc0184a208a1cd597d07faffa2cf3ba
• Lewey, J., Levine, L. D., Yang, L., Triebwasser, J. E., & Groeneveld, P. W. (2020).
Patterns of postpartum ambulatory care follow-up care among women with
hypertensive disorders of pregnancy. Journal of the American Heart Association,
9(17), e016357.
• Rammohan, R., Joy, M., Magam, S. G., Natt, D., Patel, A., Akande, O., Yost, R. M.,
Bunting, S., Anand, P., & Mustacchia, P. (2023). The path to sustainable healthcare:
Implementing care transition teams to mitigate hospital readmissions and improve
patient outcomes. Cureus, 15(5), e39022.
• Wen, T., Krenitsky, N. M., Clapp, M. A., D'Alton, M. E., Wright, J. D., Attenello, F.,
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