The nature of after-hours telephone medical practice by GI fellows

Gastroenterology fellows on-call often serve as the initial or only contact for patients calling "after hours" with questions and symptoms. These fellows are rarely trained specifically in how to handle these calls. The aim of this study was to determine whether there are particular topics in telephone medicine that ought to be covered in new fellow training. Therefore, we sought to evaluate the nature of after-hours pages initiated by patients and to document the advice given by fellows.

The content of 100 patient-initiated telephone calls with GI fellows was recorded prospectively over 7 months. We included pages received between 5 PM and 8 AM daily as well as daytime calls on weekends. Fellows documented the time and length of the call, the issue raised by the patient, the advice given, and the patient's gender and attending gastroenterologist. When a particular patient paged more than once in a 24-h period, the repeat calls were not counted toward the 100-call tally.

Twenty-two percent of calls occurred between 11 PM and 7 AM. Eighty-three percent of calls lasted less than 10 min. Sixty-seven percent of patients called because of symptoms. Only 30% of patients calling with symptoms were referred to the emergency room. Although only 1 of 13 patients with procedure-related (i.e., postendoscopy) symptoms required admission to the hospital, 18 of 54 (33%) patients with nonprocedure-related symptoms required admission either immediately or within a month of calling after hours.

Most after-hours calls from patients are related to symptoms. Patients calling with postprocedure symptoms rarely require admission to the hospital. Conversely, a significant number of patients calling with non-procedure-related symptoms require admission within 30 days. Fellowship directors should consider providing training to fellows in the evaluation of symptoms over the telephone.