title: Errors in after-hours phone consultations: a simulation study.
abstract: BACKGROUND
  After-hours out-of-hospital phone consultations require physicians to make decisions based on information provided by a nurse over the phone.
  
  
  METHODS
  We conducted a simulation study to evaluate physicians' actions following communication of key information. 22 nurses were asked to call physicians with six cases based on the six most common reasons for after-hours phone calls. We evaluated physicians' actions following the communication of key clinical information: A situation cue described a patient's problem (eg, confusion). A background cue described a specific clinical finding regarding the cause of the problem (eg, patient's sodium is low). For each cue we defined a list of indicators, based on the medical literature, to ascertain whether physicians acted upon the provided information (which was defined as addressing at least one of the indicators).
  
  
  RESULTS
  A total of 108 phone consultations (containing 88 situation and 93 background cues) were analysed. Situation cues were communicated in 90% (79/88) of the calls and background cues in 33% (31/93). Physician acted upon the provided information in 57% (45/79) and 48% (15/31) of the communicated situation and background cues, respectively. When the background cues were not communicated, physicians asked questions expected to elicit the cue in 12% of the cases. Responding to the situation cue was associated with longer conversations and active inquiry by the physician.
  
  
  CONCLUSIONS
  After-hours phone calls are error prone. Both nurse communication and physician decision-making are problematic. Efforts to improve patient safety in this setting must address both communication and decision-making.
authors: School of Biomedical Informatics, The University of Texas Health Science Center, , Houston, Texas, USA.
authors: Erel
authors: E
authors: Joffe
authors: James P
authors: JP
authors: Turley
authors: Kevin O
authors: KO
authors: Hwang
authors: Todd R
authors: TR
authors: Johnson
authors: Craig W
authors: CW
authors: Johnson
authors: Elmer V
authors: EV
authors: Bernstam
mesh_terms: D039602:After-Hours Care / Q000592:standards / Q000706:statistics & numerical data*; D003142:Communication; D006801:Humans; D019300:Medical Errors / Q000706:statistics & numerical data*; D010820:Physicians / Q000592:standards / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000592:standards / Q000706:statistics & numerical data*; D013689:Telephone
keywords: Communication; Diagnostic Errors; Hand-Off; Hospital Medicine; Human Error