TY - JOUR T1 - Errors in after-hours phone consultations: a simulation study JF - BMJ Quality & Safety JO - BMJ Qual Saf SP - 398 LP - 405 DO - 10.1136/bmjqs-2013-002243 VL - 23 IS - 5 AU - Erel Joffe AU - James P Turley AU - Kevin O Hwang AU - Todd R Johnson AU - Craig W Johnson AU - Elmer V Bernstam Y1 - 2014/05/01 UR - http://qualitysafety.bmj.com/content/23/5/398.abstract N2 - 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. ER -