@article {Joffe398, author = {Erel Joffe and James P Turley and Kevin O Hwang and Todd R Johnson and Craig W Johnson and Elmer V Bernstam}, title = {Errors in after-hours phone consultations: a simulation study}, volume = {23}, number = {5}, pages = {398--405}, year = {2014}, doi = {10.1136/bmjqs-2013-002243}, publisher = {BMJ Publishing Group Ltd}, 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{\textquoteright} 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{\textquoteright} actions following the communication of key clinical information: A situation cue described a patient{\textquoteright}s problem (eg, confusion). A background cue described a specific clinical finding regarding the cause of the problem (eg, patient{\textquoteright}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.}, issn = {2044-5415}, URL = {https://qualitysafety.bmj.com/content/23/5/398}, eprint = {https://qualitysafety.bmj.com/content/23/5/398.full.pdf}, journal = {BMJ Quality \& Safety} }