title: Evaluation of an asynchronous physician voicemail sign-out for emergency department admissions.
abstract: OBJECTIVE
  Communication failures contribute to errors in the transfer of patients from the emergency department (ED) to inpatient medicine units. Oral (synchronous) communication has numerous benefits but is costly and time consuming. Taped (asynchronous) communication may be more reliable and efficient but lacks interaction. We evaluate a new asynchronous physician-physician sign-out compared with the traditional synchronous sign-out.
  
  
  METHODS
  A voicemail-based, semistructured sign-out for routine ED admissions to internal medicine was implemented in October 2007 at an urban, academic medical center. Outcomes were obtained by pre- and postintervention surveys of ED and internal medicine house staff, physician assistants, and hospitalist attending physicians and by examination of access logs and administrative data. Outcome measures included utilization; physician perceptions of ease, accuracy, content, interaction, and errors; and rate of transfers to the ICU from the floor within 24 hours of ED admission. Results were analyzed both quantitatively and qualitatively with standard qualitative analytic techniques.
  
  
  RESULTS
  During September to October 2008 (1 year postintervention), voicemails were recorded about 90.3% of medicine admissions; 69.7% of these were accessed at least once by admitting physicians. The median length of each sign-out was 2.6 minutes (interquartile range 1.9 to 3.5). We received 117 of 197 responses (59%) to the preintervention survey and 113 of 206 responses (55%) to the postintervention survey. A total of 73 of 101 (72%) respondents reported dictated sign-out was easier than oral sign-out and 43 of 101 (43%) reported it was more accurate. However, 70 of 101 (69%) reported that interaction among participants was worse. There was no change in the rate of ICU transfer within 24 hours of admission from the ED in April to June 2007 (65/6,147; 1.1%) versus April to June 2008 (70/6,263; 1.1%); difference of 0%, 95% confidence interval -0.4% to 0.3%. The proportion of internists reporting at least 1 perceived adverse event relating to transfer from the ED decreased a nonsignificant 10% after the intervention (95% confidence interval -27% to 6%), from 44% preintervention (32/72) to 34% postintervention (23/67).
  
  
  CONCLUSIONS
  Voicemail sign-out for ED-internal medicine communication was easier than oral sign-out without any change in early ICU transfers or the perception of major adverse events. However, interaction among participants was reduced. Voicemail sign-out may be an efficient means of improving sign-out communication for stable ED admissions.
authors.affiliation: Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT 06520-8093, USA. leora.horwitz@yale.edu
authors.forename: Leora I
authors.initials: LI
authors.lastname: Horwitz
authors.forename: Vivek
authors.initials: V
authors.lastname: Parwani
authors.forename: Nidhi R
authors.initials: NR
authors.lastname: Shah
authors.forename: Jeremiah D
authors.initials: JD
authors.lastname: Schuur
authors.forename: Thom
authors.initials: T
authors.lastname: Meredith
authors.forename: Grace Y
authors.initials: GY
authors.lastname: Jenq
authors.forename: Raghavendra G
authors.initials: RG
authors.lastname: Kulkarni
mesh_terms: D000046:Academic Medical Centers / Q000379:methods / Q000458:organization & administration; D039604:Answering Services / Q000458:organization & administration*; D001291:Attitude of Health Personnel; D003142:Communication; D003146:Communications Media / Q000706:statistics & numerical data; D003266:Continuity of Patient Care / Q000458:organization & administration; D004631:Emergency Medical Service Communication Systems / Q000458:organization & administration* / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D020445:Hospitalists; D006801:Humans; D007396:Internship and Residency; D007400:Interprofessional Relations; D017063:Outcome Assessment, Health Care; D010343:Patient Admission; D010360:Patient Transfer / Q000379:methods* / Q000458:organization & administration*; D010823:Physician Assistants; D011795:Surveys and Questionnaires; D013997:Time Factors