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Patient Safety and Quality

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Pilot study suggests that after-hours telephone medical consultations may pose risks to patient safety

After-hours telephone medical consultations, which account for 25 percent of patient encounters, may pose risks to patient safety. Errors are common and adverse events are possible, suggests a new pilot study. University of Kentucky investigators interviewed 64 patients who called into the after-hours answering service of 1 family medicine practice over a 10-week period.Second- or third-year residents on backup call were paged to answer the phone calls. Two registered nurses and a physician analyzed the patient narratives to identify threats to patient safety.

Overall, 14 after-hours calls (22 percent) involved a medical error (including the doctor not returning the call in 6 cases). Four instances (6 percent) resulted in temporary physical harm. Two separate after-hours calls (3 percent) involved four medical errors with potentially serious consequences to patient safety. These included a tenfold overdose of acetaminophen and a tenfold overdose of antihistamine for a 3-month-old child with viral symptoms but no fever, and an inappropriate prescription for an antihistamine.

The fourth error was taking an incomplete history in a complicated patient, who could have been sicker than realized. Fourteen calls (22 percent) involved events that could have threatened patient safety. Thirteen percent of these cases were "saved" by the patients themselves, not medical practitioners. For example, they sought care elsewhere when the doctor did not call back, either via over-the-counter medication, pediatrician, or emergency room. On the other hand, almost half the errors were made by patients choosing not to seek care as directed.

Only 5 percent of charts of patients who called had telephone notes on them at the time of the chart review, making patient follow-up more difficult. After-hours medicine may be conducted when doctors are distracted or sleepy. It also doesn't provide the doctor with visual cues about the severity of patient illness, explain the researchers.

Their study was supported by the Agency for Healthcare Research and Quality (HS11845).

See "Patient safety in after-hours telephone medicine," by Shersten Killip, M.D., M.P.H., Carol L. Ireson, R.N., Ph.D., Margaret M. Love, Ph.D., and others in the June 2007 Family Medicine 39(6), pp. 404-409.

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