title: A quality improvement program to enhance after-hours telephone communication between nurses and physicians in a long-term care facility.
abstract: OBJECTIVE
  To determine whether satisfaction of on-site nurses with after-hours telephone communication with off-site physicians improved in one long-term care (LTC) facility after a nurse-oriented intervention.
  
  
  METHODS
  Longitudinal quality improvement study.
  
  
  METHODS
  Extended Care and Rehabilitation Center (ECRC), Durham Veterans Affairs Medical Center.
  
  
  METHODS
  Eighteen registered nurses.
  
  
  METHODS
  Communicating Health Assessments by Telephone (Project CHAT), a program of individualized training sessions and decision support tools to aid LTC nurses with symptom assessment and communication of health information over the telephone.
  
  
  METHODS
  Nurses completed six satisfaction surveys (three surveys in the 3 months before Project CHAT and three surveys in the 3 months after Project CHAT).
  
  
  RESULTS
  The nurses' average satisfaction scores increased on several items, including those that assessed whether the nurse was pretty sure what pieces of information the physician was going to ask for (P=.04), felt that the amount of patient information the physician asked for seemed reasonable (P=.03), felt prepared to answer the questions the physician asked (P=.01), and felt that the process of gathering patient information for the physician was easy (P=.01). The percentage of calls that resulted in immediate evaluation by a physician (on-site or in the emergency department) increased from 2.0% in the period before Project CHAT to 8.6% in the period after Project CHAT (P=.01).
  
  
  CONCLUSIONS
  Nurses' satisfaction with several aspects of after-hours telephone medicine improved after an inexpensive, education-based intervention in one LTC facility. Further research is needed to determine how similar interventions might affect other quality measures, including patient outcomes.
authors.affiliation: Department of Medicine, Division of Geriatric Medicine, Duke University Medical Center, Durham, North Carolina 27710, USA. heather.whitson@duke.edu
authors.forename: Heather E
authors.initials: HE
authors.lastname: Whitson
authors.forename: S Nicole
authors.initials: SN
authors.lastname: Hastings
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Lekan
authors.forename: Richard
authors.initials: R
authors.lastname: Sloane
authors.forename: Heidi K
authors.initials: HK
authors.lastname: White
authors.forename: Eleanor S
authors.initials: ES
authors.lastname: McConnell
mesh_terms: D039602:After-Hours Care; D001291:Attitude of Health Personnel; D017144:Focus Groups; D006801:Humans; D008134:Long-Term Care; D008137:Longitudinal Studies; D009735:Nursing Homes; D019555:Physician-Nurse Relations; D011785:Quality Assurance, Health Care; D013192:Staff Development; D013689:Telephone; D014481:United States; D014493:United States Department of Veterans Affairs; D000078329:Workforce