title: Analysis of After-Hours Patient Telephone Calls in Two Academic Radiation Oncology Departments: An Opportunity for Improvement in Patient Safety and Quality of Care.
abstract: OBJECTIVE
  Patient care within radiation oncology extends beyond the clinic or treatment hours. The on-call radiation oncologist is often not a patient's primary radiation oncologist, introducing the possibility of communication breakdowns and medical errors. This study analyzed after-hours telephone calls to identify opportunities for improved patient safety and quality of care.
  
  
  METHODS
  Patient calls received outside of business hours between July 1, 2013, and June 30, 2014, at two academic radiation oncology departments were retrospectively reviewed. All calls were analyzed using content analysis, and descriptive analyses were performed.
  
  
  RESULTS
  During this time, 5,557 courses of radiotherapy (RT) were delivered. A total of 454 calls were received from 369 unique patients (81%), averaging 4.4 calls per week per department. Phone encounters were documented for 223 calls (49%). The calls were categorized by disease site (No., %): central nervous system (91, 20%), head and neck (78, 17%), genitourinary (53, 12%), GI (52, 12%), thoracic (51, 11%), gynecologic (30, 7%), breast (24, 5%), and other (75, 17%). Patients most often called regarding acute medical, non-RT-related issues (144 calls, 32%); acute RT-related adverse effects (127, 28%); and medication management, including refills (63, 14%).
  
  
  CONCLUSIONS
  This analysis provided novel information regarding the volume of and reasons for after-hours patient-initiated telephone calls. It identified opportunities for actionable improvements in safety and quality of care, particularly with regard to documentation by on-call providers, communication with the primary radiation oncology and extended health care teams, patient education about common RT adverse effects, and medication management.
authors.affiliation: Harvard Radiation Oncology Program; Brigham and Women's Hospital and Dana-Farber Cancer Institute; and Massachusetts General Hospital, Boston, MA lewarren@partners.org.
authors.forename: Laura E G
authors.initials: LE
authors.lastname: Warren
authors.affiliation: Harvard Radiation Oncology Program; Brigham and Women's Hospital and Dana-Farber Cancer Institute; and Massachusetts General Hospital, Boston, MA.
authors.forename: Miranda B
authors.initials: MB
authors.lastname: Kim
authors.affiliation: Harvard Radiation Oncology Program; Brigham and Women's Hospital and Dana-Farber Cancer Institute; and Massachusetts General Hospital, Boston, MA.
authors.forename: Neil E
authors.initials: NE
authors.lastname: Martin
authors.affiliation: Harvard Radiation Oncology Program; Brigham and Women's Hospital and Dana-Farber Cancer Institute; and Massachusetts General Hospital, Boston, MA.
authors.forename: Helen A
authors.initials: HA
authors.lastname: Shih
mesh_terms: D006801:Humans; D061214:Patient Safety; D036301:Qualitative Research; D011787:Quality of Health Care / Q000592:standards / Q000706:statistics & numerical data; D018787:Radiation Oncology / Q000592:standards* / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013689:Telephone; D013997:Time Factors