A 63-year-old woman with a history of chronic obstructive pulmonary disease (COPD) presented with several days of a productive cough, shortness of breath, and fever. Based on her clinical history, physical exam, and diagnostic studies, she was diagnosed with community-acquired pneumonia and admitted to the hospital. She was treated with ceftriaxone and doxycycline, intravenous fluids, and supportive care. The patient improved rapidly over 48 hours and was discharged home (she lived with her daughter and grandson) with a prescription for doxycycline (an oral antibiotic) to complete a 7-day course and guaifenesin for a persistent cough.
Over the next few days following discharge, the patient's cough worsened, and the shortness of breath returned despite taking antibiotics. She called her primary care physician (PCP) to schedule an urgent appointment, but he was out of the country, and no appointments were available in the clinic. She also vaguely remembered being given a number at the hospital to call if she had any issues at home, but she could not locate the number in the large stack of papers she was given at discharge. As her symptoms worsened, she contemplated returning to the emergency department (ED).
That afternoon, she received a phone call from the hospital where she had been discharged. At this hospital, all patients discharged from the medicine service are called by a nurse within 3 days. The nurse asked a standard list of questions and learned about the worsening symptoms.
The nurse contacted the discharging team regarding the worsening cough and shortness of breath. The team was concerned that her pneumonia was returning and she was failing the doxycycline treatment. They contacted her local pharmacy and were able to prescribe levofloxacin (a broader spectrum antibiotic). The patient's daughter was able to get the prescription the same day and the patient began taking the levofloxacin.
The nurse who had called previously called again 2 days later to check on the patient. With the change in antibiotics, the patient felt much better with improving symptoms. She did not need to return to the hospital and was able to see her primary care doctor 2 weeks later. The discharging team was convinced that the follow-up phone call by the nurse had definitely prevented a return visit to the ED and potentially a readmission to the hospital.
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