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After-hours telephone triage affects patient safety
David E Hildebrandt1, John M Westfall, Peter C Smith
1Rose Family Medicine Residency, Denver, CO 80222, USA. hildebrd@rfmr.com
The Journal of Family Practice
|March 7, 2003
Summary
After-hours call systems in primary care often delay patient care. Patients frequently decide if calls are urgent, but physicians found 50% of non-forwarded calls were emergencies needing immediate attention.
Area of Science:
- Primary Care Medicine
- Healthcare Management
- Patient Safety
Background:
- After-hours calls are crucial for patient care continuity in primary care settings.
- Existing systems for managing these calls may present challenges to timely evaluation and treatment.
Purpose of the Study:
- To evaluate the management protocols for after-hours calls in primary care.
- To identify potential system-induced errors that could impede prompt patient assessment and intervention.
Main Methods:
- A survey of 91 primary care offices (family medicine, internal medicine, obstetrics, pediatrics) was conducted.
- An audit of after-hours phone calls, including a review of calls not initially forwarded to on-call physicians, was performed.
- Independent physician reviewers assessed the urgency of calls that were not forwarded.
Main Results:
- Over two-thirds of surveyed offices utilized answering services for after-hours calls.
- In 93% of practices, patients were responsible for determining the urgency of their condition for physician notification.
- Physician reviewers identified 50% of calls not forwarded as emergencies requiring immediate physician contact.
Conclusions:
- Current after-hours call management systems in primary care can create barriers to timely medical care.
- Clinical calls after hours should be triaged by trained medical personnel.
- Primary care clinicians using answering services should review their policies to mitigate medical errors.