BACKGROUND: After-hours out-of-hospital phone consultations require physicians to make decisions based on information provided by a nurse over the phone.
METHODS: We conducted a simulation study to evaluate physicians' actions following communication of key information. 22 nurses were asked to call physicians with six cases based on the six most common reasons for after-hours phone calls. We evaluated physicians' actions following the communication of key clinical information: A situation cue described a patient's problem (eg, confusion). A background cue described a specific clinical finding regarding the cause of the problem (eg, patient's sodium is low). For each cue we defined a list of indicators, based on the medical literature, to ascertain whether physicians acted upon the provided information (which was defined as addressing at least one of the indicators).
RESULTS: A total of 108 phone consultations (containing 88 situation and 93 background cues) were analysed. Situation cues were communicated in 90% (79/88) of the calls and background cues in 33% (31/93). Physician acted upon the provided information in 57% (45/79) and 48% (15/31) of the communicated situation and background cues, respectively. When the background cues were not communicated, physicians asked questions expected to elicit the cue in 12% of the cases. Responding to the situation cue was associated with longer conversations and active inquiry by the physician.
CONCLUSIONS: After-hours phone calls are error prone. Both nurse communication and physician decision-making are problematic. Efforts to improve patient safety in this setting must address both communication and decision-making.
}, year = {2014}, journal = {BMJ Qual Saf}, volume = {23}, pages = {398-405}, month = {05/2014}, issn = {2044-5423}, doi = {10.1136/bmjqs-2013-002243}, language = {eng}, }