Leveraging Primary Care Resources Through Quality Improvement to Increase Follow-up After Mental Health Emergency Department Visits

Abstract

Introduction: Timely follow-up after mental behavioral health (MBH) crises can improve health outcomes; moreover, it is a national quality metric. We aimed to improve the completion of 7-day follow-up after emergency department (ED) discharge for youth with an MBH concern from 28.7% of discharges to 50.0% within 12 months. Methods: We used quality improvement methods from November 1, 2024, to October 31, 2025, across 3 primary care sites and 2 ED sites. Baseline data, literature reviews, and lived experience identified key drivers and failure modes. We developed 2 interventions: (1) direct phone outreach after discharge and (2) increased access in pediatric primary care (PPC). The primary outcome measure was the percentage of ED MBH discharges with a completed follow-up appointment within 7 days of discharge. Process measures included the percentage of patients who received a postdischarge outreach call and who followed up within PPC. The balancing measure was return ED MBH visits within 30 days. Results: The mean follow-up percentage increased from 28.7% (n = 258) to 40.3% (n = 334). Follow-up for Medicaid-insured patients increased from 24% to 35% and remained stable for commercially insured patients (42%), decreasing our equity gap by 11%. Outreach calls occurred following 52.4% of discharges. Follow-up visits within PPC increased from 3.5% of discharges to 10.7% of discharges. There was no change in return ED visits within 30 days of ED discharge. Conclusions: Increasing access to pediatric primary care and implementing timely postdischarge follow-up calls can improve follow-up within a large healthcare system for patients discharged from the ED for MBH concerns.