Bernstam, E. V., Pancheri, K. K., Johnson, C. M., Johnson, T. R., Thomas, E. J., Turley, J. P., Reasons for after-hours calls by hospital floor nurses to on-call physicians.,
Joint Commission journal on quality and patient safety / Joint Commission Resources, vol. 33 no. 6
(June, 2007),
pp. 342-9, ISSN 1553-7250
(last updated on 2011/02/11)
Abstract:
BACKGROUND: Communication failure is a common root cause of preventable medical errors affecting hospitalized patients. A study was conducted to determine the reasons for calls made by nurses working on the general medical wards to on-call physicians from 6:00 P.M. to 7:00 A.M. METHODS: A retrospective review was performed of a random sample of 500 inpatients admitted to general medical wards at an urban public teaching hospital in Houston between January 1, 2000, and February 28, 2003. RESULTS: In 139 (47%) of 293 medical records there were 304 documented calls. The majority of calls (81%) took place between 6:00 P.M. and 2:00 A.M., with peak call volume between midnight and 2:00 P.M. Patients with one or more calls had an average of 2.2 calls during their stay. Ten categories accounted for 65% of all the nurse calls. In 44% of calls, physicians responded by ordering a medication. DISCUSSION: Communication between floor nurses and on-call physicians might be improved by several interventions. Because 10 reasons accounted for 65% of after-hours calls, protocols could allow nurses to resolve some acute problems without physician involvement. For example, appropriate standing orders (e.g., PR.N. medications) may prevent some calls. In addition, sign-out procedures can be tailored to address common problems that are likely to require future telephone communication. With efforts to change error-prone systems, it seems prudent to focus on after-hours coverage.
Keywords:
After-Hours Care • Communication* • Hospital Administration* • Hospitals, Teaching • Hospitals, Urban • Humans • Medical Staff, Hospital* • Nursing Staff, Hospital* • Retrospective Studies • Telephone • organization & administration • organization & administration*
