Subinternship Medicine · Year 4 · from Subinternship Medicine
Case 2: Transition Phone Call and Early Follow-Up
Clinical Image
Source: Wikimedia Commons - Healthcare Communication - CC BY-SA 3.0
Case Presentation
A 67-year-old man with diabetes and coronary artery disease is discharged after a 4-day hospitalization for NSTEMI treated with PCI and stent placement. He was started on dual antiplatelet therapy (aspirin and clopidogrel), atorvastatin was increased to 80 mg, and metoprolol was added. The sub-intern makes a transition phone call 48 hours after discharge. She uses a structured approach: "How are you feeling since you got home?" He reports doing well overall but mentions mild dizziness when standing. She asks about medications: "Can you tell me what heart medications you are taking?" He correctly identifies aspirin, clopidogrel, and atorvastatin but has not started the metoprolol because he "couldn't get it filled." The pharmacy was out of stock, and he did not know to go elsewhere. She identifies this medication access barrier and helps him locate an alternative pharmacy with same-day pickup. She asks about warning signs: "Do you remember what symptoms should bring you back to the hospital?" He correctly identifies chest pain but does not mention shortness of breath or severe bleeding. She reinforces these return precautions. She confirms his cardiology follow-up is scheduled in 1 week and PCP follow-up in 2 weeks. She documents the call, noting the medication access issue that was resolved and the additional education provided. She alerts the outpatient cardiologist about the delayed metoprolol start via secure message.
Key Learning Points
- Transition phone calls (within 24-72 hours post-discharge) identify early problems before they lead to readmission
- Structured call elements: check on patient, review medications, assess symptoms, identify barriers, and confirm follow-up
- Medication access barriers (cost, pharmacy stock, transportation) are common and often discovered only after discharge
- Communication with outpatient providers about discharge events and transition issues ensures continuity of care