Patient safety in after-hours telephone medicine.
OBJECTIVE
This study analyzed our family medicine department's after-hours telephone medicine systems at an academic health center from a patient safety perspective. The research questions were (1) What are the threats to patient safety associated with after-hours telephone medicine and (2) What kinds of errors are made during after-hours telephone medicine?


METHODS
Subjects were patients at the University of Kentucky family medicine practice who called in to the after-hours answering service. Telephone interviews were conducted with 64 patients over 10 weeks. During the interviews, patients described their telephone medicine experience, identified any problems, and reported potential or actual harm (patient-identified threats to patient safety). Two registered nurses and one physician analyzed the patient narratives to identify threats to patient safety (medical personnel-identified threats to patient safety).


RESULTS
Sixty-three analyzable patient interviews identified four instances (6%) of temporary physical harm. Two separate after-hours calls (3%) involved four medical errors with potentially serious consequences to patient safety (wrong dose, serious illness not ruled out). Fourteen calls (22%) involved events that could have threatened patient safety.


CONCLUSIONS
Situations that threaten patient safety occur frequently in telephone medicine. Although this study is too small to draw strong conclusions, it suggests that there are risks to patient safety associated with after-hours telephone medicine.
Killip
Shersten
S
Department of Family and Community Medicine, University of Kentucky, K302 Kentucky Clinic 0284, 740 S. Limestone, Lexington, KY 40536-0284, USA. skill2@email.uky.edu
Ireson
Carol L
CL
Love
Margaret M
MM
Fleming
Steven T
ST
Katirai
Whitney
W
Sandford
Katherine
K
D000046:Academic Medical Centers; D000328:Adult; D039602:After-Hours Care / Q000592:standards*; D000368:Aged; D005194:Family Practice / Q000592:standards*; D006302:Health Services Research; D015277:Hotlines / Q000592:standards*; D006801:Humans; D007253:Information Centers / Q000592:standards*; D007407:Interviews as Topic; D007629:Kentucky; D008485:Medical Audit; D019300:Medical Errors / Q000145:classification* / Q000517:prevention & control; D008875:Middle Aged; D010349:Patient Compliance; D019114:Remote Consultation / Q000592:standards*; D017751:Safety Management; D013689:Telephone / Q000592:standards*