Errors in after-hours phone consultations: a simulation study

Abstract

BackgroundAfter-hours out-of-hospital phone consultations require physicians to make decisions based on information provided by a nurse over the phone.MethodsWe 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: Asituation cuedescribed a patient's problem (eg, confusion). Abackground cuedescribed 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).ResultsA 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.ConclusionsAfter-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.

Korean nurses’ perception and performance on communication with physicians in clinical deterioration

“…To measure nurses' communication practice with physicians in clinical deterioration, we reviewed relevant studies and literature [17,[26][27][28] and developed 30 preliminary items based on the guidelines for communication with physicians using the SBAR process developed by the Institute for Healthcare Improvement. [14] The preliminary items were developed specifically for the preparation stage, during which nurses prepare to contact a physician by structuring their communication about clinical deterioration and the SBAR process during communication.…”