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"It's like having a nurse in the family."

A quality initiative with expected outcomes of decreased re-admissions, reduction in emergency room utilization and an increase in primary care physician follow up adherence.

This program is a nurse follow up phone call to patients that are 65 years of age and older, that have been treated in one of the adult ED's, discharged home and have heart failure in their problem list. The phone call is made within 24 hours of discharge from the ED and focuses on five components.

  1. General Health information- How are you feeling? Do you need anything to help in your recovery process? Are you in uncontrollable pain?
  2. Home Care Services- Now that you are home, are you able to complete your activities for daily living? Are you able to climb stairs? Do you need medical equipment in your home?
  3. Medications- Have you picked up prescribed medications from pharmacy? Do you have a pill box? Do you understand the changes in your medication since visiting the ED?
  4. Follow up appointment-Do you have a follow up appointment? Do you know where it is? When it is? Do you have a ride?
  5. What to do in an emergency- Phone number is provided for Tele-Caring. Reminder that we provide 24 hour access to care or health information questions.

Health Links Tele-Caring Podcast


Tele-caring at Upstate