Reasons for after-hours calls by hospital floor nurses to on-call physicians.
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.


CONCLUSIONS
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.
Bernstam
Elmer V
EV
Department of Internal Medicine, University of Texas Health Science at Houston, USA.
Pancheri
Karen K
KK
Johnson
Constance M
CM
Johnson
Todd R
TR
Thomas
Eric J
EJ
Turley
James P
JP
D039602:After-Hours Care / Q000458:organization & administration*; D003142:Communication; D006739:Hospital Administration; D006784:Hospitals, Teaching / Q000458:organization & administration; D006786:Hospitals, Urban / Q000458:organization & administration; D006801:Humans; D008505:Medical Staff, Hospital; D009741:Nursing Staff, Hospital; D012189:Retrospective Studies; D013689:Telephone