Killip S, Ireson CL, Fleming ST, Love MM, McLay CM, Katirai WJ; AcademyHealth. Meeting (2005 : Boston, Mass.).
Abstr AcademyHealth Meet. 2005; 22: abstract no. 4244.
University of Kentucky, Family and COmmunity Medicine, K 302 KY Clinic 0284, Lexington , KY 40536 Tel. 859-323-5917 Fax 859-323-6661
RESEARCH OBJECTIVE: The purpose of this project was to analyze the telephone medicine systems at an academic health center from a systems perspective, looking for potential threats to patient safety. The research questions included: (1) Are there currently gaps in our telephone care system which may contribute to patient adverse events? and (2) Can a systems based evaluation method be developed to identify key components in patient safety as it relates to telephone medicine? STUDY DESIGN: This study used both quantitative and qualitative design elements. Telephone interviews were conducted with a sample of 64 patients over 10 weeks. Analyses of the outcomes from each telephone call, including systems-level outcomes (was the patient called back, did the message get to the primary care doctor, etc) and patient-level outcomes (checking that the patients felt better/followed instructions/did not suffer any adverse events) were done. Interviews were conducted with all residents and attendings at the University of Kentucky Family Practice in person. Process data from these interviews were analyzed for existing and actual weaknesses in the system. POPULATION STUDIED: The populations studied in this project are UKFP faculty, the UKFP residents, and the English, Spanish, or French-speaking adult patient population of the UKFP Clinic. The University of Kentucky Medical Center is an academic health center that draws on a wide area with the principal catchment area being the eastern half of the state. The Family Practice Residency is staffed with 9 faculty and 18 family practice residents. PRINCIPAL FINDINGS: Preliminary findings identified significant gaps in our telephone system, as well as patient satisfaction issues. Almost 10% of phone calls went unanswered, and nearly a third of patients rated their experience as poor. The majority of patients understood and followed the physicians recommendations which were a visit to the emergency room or an over the counter medication. Less than a third of patients sought no further care after their telephone call. An unexpected finding was that the majority of callers were proxies for the actual patients (i.e. mothers calling for children), adding yet another layer of complexity to telephone medicine. CONCLUSIONS: The telephone medicine system at the UKFP has system and patient satisfaction problems. Problems with patient safety were implied by failure to answer calls, but few actual adverse events were reported. This is not surprising given the small sample size and the level of intervention usually done over the phone; however, the level of potential harm was quite high. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: Telephone medicine is a large part of ambulatory patient care, and it has rarely been investigated for patient safety issues as they relate to the telephone systems. This study will allow us to redesign our telephone system to better care for patient safety. A future project will evaluate the results of our intervention, then disseminate it to several related sites. Should this intervention be successful, and reproducible at other sites, the implications for the practice of telephone medicine could be enormous.
Publication Types:
Keywords:
- Adult
- Child
- Family Practice
- Humans
- Internship and Residency
- Kentucky
- Patient Satisfaction
- Physicians
- Primary Health Care
- Telephone
- therapy
- hsrmtgs
UI: 103623707
From Meeting Abstracts