After-hours Telephone Research Articles

Utilisation of after-hours telephone support in a home-based hospice service

BackgroundAfter-hours support from hospice providers is instrumental to patients with serious illness who choose to remain at home, particularly at end of life. Utilisation of out-of-hours support has been much characterised in terms of frequency and nature of calls, but more needs to be known to inform service customisation and resource allocation to optimise care. To this end, we stratify reasons for using the after-hours helpline according to time sensitivity, and to explore disease and person factors associated with urgent calls.MethodElectronic medical records for incoming calls from external parties outside workhours within a large home hospice in Singapore were analysed inductively, to identify patterns and associations along study objectives. Individual code books for caller type and call reasons were created and tested in vivo, and later administered to extracted data. Patients that accessed the helpline were tracked for different outcomes, including hospital admissions and on-call home visits. Logistic regression modelling was performed to categorise call reasons by urgency and to identify disease and person factors associated with time sensitive calls.ResultsMore than 5,000 calls to the helpline were made over a two-year period (2019-2020), predominantly by family caregivers (88.4%). These were in relation to 2,303 unique patients (38.9% of total patients served). After-hours calls were made an average of 2.3 times by patients across various lengths of service. Only 11.9% of calls were deemed time sensitive or urgent, requiring home visits by on-call staff (4%) or resulting in admission to hospital (7.9%). The majority were managed by primary care teams on the next workday (65.1%) and the remainder sorted during the after-hours call itself (22.3%). Call reasons or presenting issues were classified into two groups according to urgency. Calls in the year 2020, from the younger patient, preferred place of death outside the home, and caller types other than patient or healthcare worker were significantly associated with urgent calls.ConclusionDeeper characterisation of after-hours calls offers possibilities: service redesign for optimal resourcing and customised training for better care. Ultimately, planners, providers, and patients all stand to benefit.

Exploring the role of nurses in after-hours telephone services in regional areas; A scoping review.

IntroductionThe management of patients who need chronic and complex care is a focus of attention internationally, brought about by an increase in chronic conditions, requiring significantly more care over longer periods of time. The increase in chronic conditions has placed pressure on health services, financially and physically, bringing about changes in the way care is delivered, with hospital avoidance and home-based care encouraged. In this environment, nurses play an important role in co-ordinating care across services. This review formed one part of a funded project that explored the nurse navigator role within a proposed 24-hour telephone-call service in one regional area that has a diverse population in terms of cultural identity and geographical location in relation to service access.AimThe review reports on the extant literature on the nurse’s role in the provision of afterhours telephone services for patients with chronic and complex conditions. The specific aim was to explore the effectiveness of services for patients in geographically isolated locations.MethodsThe methodological approach to the review followed the Preferred Reporting System for Meta-Analyses (PRISMA) guidelines. A thematic analysis was used to identify themes with chronic care models underpinning analysis.ResultsThree themes were identified; nurse-led decision making; consumer profile; and program outcomes. Each theme was divided into two sub-themes. The two sub-themes for decision making were: the experience of the staff who provided the service and the tool or protocol used. The two sub-themes for consumers profile were; the geographic/demographic identity of the consumers, and consumer satisfaction. The final theme of outcomes describes how the effectiveness of the service is measured, broken into two sub-themes: the economic/workforce outcomes and the consumer outcomes.DiscussionThe provision of an after-hours telephone service, in whatever model used should align with a Chronic Care Model. In this way, after-hours telephone services provided by experienced nurses, supported by ongoing professional development and relevant protocols, form part of the ongoing improvement for chronic and complex care management as a health priority.

Abstract #431 Endocrinology Fellows’ Confidence and Skills in After-Hours Telephone Medicine

Abstract #431 Endocrinology Fellows’ Confidence and Skills in After-Hours Telephone Medicine

Analysis of After-Hours Patient Telephone Calls in Two Academic Radiation Oncology Departments: An Opportunity for Improvement in Patient Safety and Quality of Care.

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. 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. 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%). 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.

Improving Resident Performance in an After-Hours Pediatric Telephone Triage Service

Improving Resident Performance in an After-Hours Pediatric Telephone Triage Service

Employees’ views on home-based, after-hours telephone triage by Dutch GP cooperatives

BackgroundDutch out-of-hours (OOH) centers find it difficult to attract sufficient triage staff. They regard home-based triage as an option that might attract employees. Specially trained nurses are supposed to conduct triage by telephone from home for after-hours medical care. The central aim of this research is to investigate the views of employees of OOH centers in The Netherlands on home-based telephone triage in after-hours care.MethodsThe study is a Q methodology study. Triage nurses, general practitioners (GPs) and managers of OOH centers ranked 36 opinion statements on home-based triage. We interviewed 10 participants to help develop and validate the statements for the Q sort, and 77 participants did the Q sort.ResultsWe identified four views on home-based telephone triage. Two generally favor home-based triage, one highlights some concerns and conditions, and one opposes it out of concern for quality. The four views perceive different sources of credibility for nurse triagists working from home.ConclusionHome-based telephone triage is a controversial issue among triage nurses, GPs and managers of OOH centers. By identifying consensus and dissension among GPs, triagists, managers and regulators, this study generates four perspectives on home-based triage. In addition, it reveals the conditions considered important for home-based triage.

Effects of an Education and Training Intervention on Caregiver Knowledge of Nonurgent Pediatric Complaints and on Child Health Services Utilization

The objective of this study was to test the impact of an education and training intervention about management of common childhood illnesses on caregiver knowledge and health service use by an index child. This was a quasi-experimental, preintervention-postintervention pilot study of a primary care-based intervention among 32 caregivers of urban children aged 7 months to 5 years. Intervention consisted of a 90-minute educational activity developed after input from focus groups and taught by pediatric nurses; it addressed management of fever, colds, and minor trauma in children at home. Caregiver knowledge before, immediately after, and 6 months after intervention was tested using a written instrument. Health services utilization for an index child in the family was collected 6 months before and after intervention. Caregiver knowledge, as assessed by mean score on the test instrument, increased immediately after the intervention. It was lower at 6-month follow-up but remained higher than pretest. Total health services utilization, adjusted for patient and caregiver factors, did not change significantly 6 months after the intervention. After-hours calls to the primary care physician increased from a mean of 0.33 to 1.46 per patient (P = 0.047), making it the only behavior with significant change. Preintervention health services utilization was the strongest positive predictor of postintervention health services use. The primary care-based intervention led to increased caregiver knowledge regarding management of common minor childhood illnesses and to increased after-hours telephone use. There was no significant decrease in ED use. To reduce reliance on the ED for nonurgent conditions, additional strategies may be needed.

PC-FACS

PC-FACS

Avoidable After-Hours Calls to Physicians in Family Medicine

To assess avoidability in after-hours telephone calls. Identification of predictors of avoidable calls is necessary so that system changes can be implemented in the interest of efficiency in patient care. A new after-hours family physician call service was established in a large group practice to replace some of the resident call shifts and meet patient expectations. Call logs completed by physicians who were on call. A total of 131 completed after-hours calls. AVOIDABLE CALL: An after-hours call to a physician that could have been effectively handled by another person, by a communication mechanism, or at another time. ASSESSMENT RESULT: Call defined as avoidable or not avoidable as assessed by the physician on call. Less than half (41.9%) of calls were avoidable. Run charts failed tests for shifts and runs. Patient age, time of day, and day of the week were not related to being avoidable, but avoidability varied by physician (P = .003). The after-hours call service experienced high rates of avoidable calls. Avoidability was associated with the physician on call. Reducing avoidable after-hours calls to physicians will require building clinical consensus on which types of calls should be considered avoidable and how avoidable calls should be redirected.

A Descriptive, Retrospective Study of After-hours Calls in Hospice and Palliative Care

AIMS: Few studies have described after-hours calls in hospice patient care. This retrospective study examines the timing of after-hours telephone triage services; the reasons for access to after-hours hospice and palliative care services; and the predominant nursing interventions offered in after-hours calls in hospice and palliative care. METHODS: A fixed coding scheme was used to code a de-identified after-hours triage phone log of all calls between July 2005 and June 2006 (n=4,434) from a Pennsylvania hospice and palliative care services organization. Descriptive statistics were used to identify call timing pattern, call reasons, and predominant nursing interventions. RESULTS: Triage services were utilized most frequently to request assistance with signs and symptoms control (25.7%), report death (17.8%), and to request a home visit (15.3%). The top nursing interventions included updating case managers or supervisors about the needs of follow-up (29.5%), coordinating home visits (20.5%), and instructing caregivers or patients on how to control new signs and symptoms (19.8%). CONCLUSIONS: A better understanding of when and why patients and their family caregivers utilize after-hours hospice triage services can assist in the design of future proactive interventions to improve care, and enhance training for new and existing hospice triage nurses.

DBT Telephone Skills Coaching With Eating Disordered Clients: Who Calls, for What Reasons, and for How Long?

The goal of this paper is to report on the typology, frequency, and duration of intersession calls placed by outpatient eating disorder clients to their therapists. Participants were 17 women, offered DBT after-hours telephone coaching adapted for individuals with eating disorders. Results indicated that clients used telephone coaching primarily to reduce eating disorder–related urges, followed by nutrition consultation. The average number of calls received by the DBT therapist per day was .89 ( SD = 2.38) with a range of 0 to 4 calls per day. The mean duration in minutes for a coaching call was 5.92 ( SD = 4.66) with a range of 1 to 30 minutes. Illustrative vignettes using the DBT telephone coaching protocol for eating disorders are provided. Implications for implementing DBT telephone coaching in settings with eating disorder patients are discussed.

Testing the safety of after-hours telephone triage: Patient simulations with validated scenarios

Summary Background The aim of this study is to estimate the appropriateness of recommended dispositions made in response to calls to after hours services offering telephone triage, usually involving nurses. The setting was five local trials sponsored by the Australian government aimed at addressing problems in after hours general practice service provision. All five trials offered telephone triage though the form of this varied considerably. Methods The study was a prospective service audit. Simulated patient calls using validated patient care scenarios with different levels of clinical significance were developed by a consensus panel of experts. Sixty telephone calls were monitored by a member of the research team to assess whether provider responses were in conformity with recommended dispositions. Results Services fell well short of a 100% appropriate response rate across all five trials. Services generally performed poorly for cases with high clinical implications such as presumed meningococcal meningitis and gastroenteritis with dehydration in a child. In general, problems of undertriage were more common than overtriage. Conclusions The safety of dispositions of telephone triage services requires further study. Simulated patient calls may be more useful for quality improvement purposes than the usual method of random audit of audiotaped calls of real patients using service records.

Studies Provide the 411 on Telephone Medicine

Studies Provide the 411 on Telephone Medicine

Improving coordination of care for Aboriginal people with mental health, alcohol and drug use problems: progress report on an ongoing collaborative action research project

This paper outlines the background and progress to date of a project to improve the coordination of care for Aboriginal people with mental health and/or alcohol and other drug problems living in the Eyre Peninsula region of South Australia. The project responds to recommendations from previous research by this team in this area, and has been running since 2004. Working with a wide range of health and human service providers, we explored issues that improve or hinder coordination of care and identified useful strategies. Some of these have already been implemented through the project: e.g. interagency cross-disciplinary training in response to shared needs, and lobbying for after-hours telephone help. Other strategies are still in progress: e.g. implementing a uniform triage and referral system and improving information sharing within Port Lincoln Aboriginal Health Service. The paper reflects on our experience of conducting Aboriginal health service research using a participatory action oriented approach, and discusses the challenges in providing effective and well coordinated rural and remote mental health/alcohol and other drug care in the context of complex health and social needs of Aboriginal people.

Supporting Patients and Their Caregivers After-Hours at the End of Life: The Role of Telephone Support

Twenty-four hour access is accepted as a gold standard for palliative care service delivery, yet minimal data exist to justify the cost of this initiative to health care planners and policy makers. Further, there is scant information concerning optimal and efficient methods for delivering after-hours palliative care advice and support, particularly in regional and rural settings. This article reports on an evaluation of a local after-hours telephone support service in regional Australia. A centralized after-hours telephone support service was provided by generalist nurses at a Multipurpose Service in a rural community. A mixed-method evaluation, including semistructured interviews, was undertaken after 20 months of operation. During the period March 31, 2005 until November 15, 2006, 357 patients were registered as part of the Mid North Coast Rural Palliative Care Program. Ten percent of patients or their caregivers accessed the After-Hours Telephone Support Service, representing 55 occasions of service. The most common reason for contacting the service was for reassurance surrounding medication usage, symptom management, and anxiety. This experience demonstrates proof of concept that acceptable palliative care advice can be provided by generalist nurses in a cost-efficient manner. Common patterns emerged in utilization that can assist in service planning and staffing formulae. There is also a need to investigate mechanisms of interfacing with larger scale call centers, to explore the differences within generic and disease-specific approaches, and assess the appropriateness of after-hours telephone support with different cultural groups.

A Quality Improvement Program to Enhance After‐Hours Telephone Communication Between Nurses and Physicians in a Long‐Term Care Facility

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. Longitudinal quality improvement study. Extended Care and Rehabilitation Center (ECRC), Durham Veterans Affairs Medical Center. Eighteen registered nurses. 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. Nurses completed six satisfaction surveys (three surveys in the 3 months before Project CHAT and three surveys in the 3 months after Project CHAT). 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). 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.

After‐Hours Calls from Long‐Term Care Facilities in a Geriatric Medicine Training Program

To describe after-hours telephone calls from nurses in long-term care (LTC) facilities to doctors in a geriatric medicine training program. Evaluation of 1,928 after-hours calls from LTC facilities over a 10-month period in 2005/06. Geriatrics fellowship program and three affiliated LTC facilities. Eight geriatrics fellows and 40 medicine interns. Data were collected on call characteristics (such as reason for call and call outcome) and physician attitudes about the call, scored using a 5-point Likert scale. Clinical problems were the focus of 70.4% of the calls. The range of clinical problems was broad; most common reasons for calls were falls (n=377), pain (n=138), and agitation (n=100). The majority of calls resulted in medical intervention, including new medications or treatments (43.4%), diagnostic tests (10.2%), or more-extensive medical evaluation in the emergency department (9.1%) or by an on-site physician (2.4%). Overall, physician trainees had favorable attitudes about most after-hours calls, although medicine interns taking calls had a less-favorable impression and felt less prepared to manage them. After-hours telephone calls from LTC facilities are common, reflect the heterogeneity of geriatric health concerns, and typically result in intervention. As the LTC population grows, more study is needed on telephone care and optimal strategies for training physicians in this important aspect of LTC.

Rural healthcare provider opinions about implementation of an after-hours rural telephone triage system

We would like to draw your readers’ attention to a small study investigating the use of a telephone triage system to improve after-hours access to healthcare services. We conducted the trial in Kerang District Hospital (KDH), located in the rural Loddon Mallee region of Northern Victoria, Australia. KDH serves 10 000 people in several districts with six GPs (ratio of 0.6/10,000 people vs Melbourne’s 10.6/10,000) 1 . With the doctor shortage and no after-hours care, KDH sought to improve healthcare access by adapting and implementing the WestVic telephone triage system 2 in 2005. This project, which evaluated staff opinions about the system 8 months later, was a joint effort between KDH staff and The University of Melbourne medical students who were undertaking a required rural experience course.

Development and Implementation of the TrAC (Tracking After-hours Calls) Database: A Tool to Collect Longitudinal Data on After-Hours Telephone Calls in Long-Term Care

Effective telephone communication between long-term care (LTC) nurses and physicians is an integral part of high-quality care, yet little is known about this key aspect of LTC practice. The authors describe the development and implementation of the TrAC (Tracking After-hours Calls) system, an electronic database designed to collect longitudinal data on after-hours telephone calls from LTC facilities. A relational database was developed to systematically record key characteristics of calls received from LTC facilities, including the date, time, location and reason for each call (new symptom/event, lab or x-ray report, verify admission orders, order clarification, other). Physicians also recorded their actions based on the call and their impression of 5 aspects of the telephone encounter. A daily report of after-hours calls was generated using the electronic call log software and delivered to patients' primary care providers and LTC facility personnel. Eight geriatric medicine fellows and 40 internal medicine interns participated in the initial implementation of the database. Over a 10-month period, data were collected on 2015 calls. Call reporting was sustained over time (mean calls per week 47.6, SD 8.2) and data collection was complete (<1.5% missing values). The most common reasons for calls to the physician were falls (17%) and lab or x-ray reports (11%). Overall, 75% of calls were for clinical problems. At the end of the study period, the geriatrics clinical group decided to adapt the TrAC database for continued use in routine clinical practice. Use of the TrAC database was a feasible way to collect longitudinal data on telephone communication between nurses and physicians in LTC. The system can be used for the development and evaluation of quality improvement programs and as an educational tool in geriatrics training programs.

How Safe Is Triage by an After-Hours Telephone Call Center?

Our goals were to assess (1) compliance with nurse disposition recommendations, (2) frequency of death or potential underreferral associated with hospitalization within 24 hours after a call, and (3) factors associated with potential underreferral, for children receiving care within an integrated health care delivery organization who were triaged by a pediatric after-hours call center. The study population included all pediatric patients enrolled in Kaiser Permanente Colorado whose families called the Children's Hospital after-hours call center in Denver, Colorado, during the period between October 1, 1999, and March 31, 2003. Postcall disposition recommendations were categorized as urgent (visit within 4 hours), next day (visit in > 4 hours but within 24 hours), later visit (visit in > 24 hours), or home care (care at home without a visit). Compliance with the nurses' triage disposition recommendations was calculated as the proportion of cases for which utilization data matched the disposition recommendations. Of the 32,968 eligible calls during the study period, 21% received urgent, 27% next day, 4% later visit, and 48% home care disposition recommendations. Rates of compliance with both urgent and home care disposition recommendations were 74%, and the rate of compliance with next day recommendations was 44%. No deaths occurred within < 1 week after the after-hours calls. The rate of potential underreferral with subsequent hospitalization was 0.2%, or 1 case per 599 triaged calls. In multivariate modeling, age of < 6 weeks or > 12 years and being triaged after 11 pm were associated with higher rates of potential under-referral. Approximately three fourths of families complied with recommendations for their child to be evaluated urgently or to be treated at home, with much lower rates of compliance with intermediate dispositions. The rate of potential underreferral with hospitalization was low, and age and time of call triage were associated with this outcome.