Purpose: Our objective was to assess and categorize harm occurring to patients who called their physicians' office after-hours but did not have their call forwarded to the physician because they stated that their call was not an emergency.Methods: We collected data on 4949 calls handled by our answering service for 1 year in a family medicine residency office in Denver, CO. Of the 2835 after-hours clinical calls, we reviewed all 288 clinical calls that were not forwarded to the "on-call" physician. Complete data on 119 clinical calls included reason for call, frequency of next day appointments, Emergency Department visits, hospital admissions and outcomes. Outcomes were reviewed and coded for harm to the patient by experienced medical errors coders.Results: When patient calls were not forwarded, 51% had an appointment, 4% an Emergency Department visit, and 2% were admitted to the hospital within 2 weeks. Analysis revealed that 3% suffered harm, and 26% experienced discomfort due to the delay. Although 66% required no intervention, 1% required emergency transport and 4% a medication change. Conclusions: Harm may occur when patients' calls are not forwarded to the on-call physician. Although the level of harm is generally temporary and minimal, the potential exists for serious harm to occur. Physicians need to re-evaluate the way they handle after-hours calls. (J Am Board Fam Med 2006; 19:437-42.)Over the past 10 years, the majority of studies of patient safety have focused on the hospital setting. A great deal of time, money, and energy has been spent identifying types of errors and system problems.1-3 The frequency of errors has varied from 6% to 18% with only a small portion of those errors resulting in permanent harm or death to the patients treated. 4 Naturally, serious harm has garnered the most attention. 5 Recently, attention has been focused on the ambulatory care settings, where errors may be even more frequent. For example, in the ambulatory care setting, adverse drug events may occur at a rate that is 4 times higher than that found in the hospital setting.

PURPOSE Our objective was to describe patients who telephone frequently after hours to physicians (frequent callers) and categorize their medical problems and resource utilization. METHODSCharts of frequent callers were reviewed and compared with those of a systematically selected group from the same family medicine residency practice (control group). Data collected included demographic and clinical information, as well as information on utilization of offi ce, emergency department, and hospital services. In addition, 4 family physicians reviewed the patient information and identifi ed the primary diagnosis for frequent callers.RESULTS Frequent callers were predominately female; had 3 times as many offi ce visits, diagnoses, and medications; and had 8 times as many hospital admissions as the control group. The most common primary diagnostic categories were psychiatric disorders (36%), pain (21%), chronic illnesses (16%), pregnancy (13%), and common problems of childhood (9%).CONCLUSIONS Frequent callers represent a unique group of patients with high utilization of health care services. Better targeted patient education and referral to other support services may decrease the number of calls and utilization of health services. Alternatively, among high utilizers, frequent telephone calls may be a substitute for other forms of care.