Hildebrandt David E, Westfall John M, Smith Peter C
Rose Family Medicine Residency, Denver, CO 80222, USA.
J Fam Pract. 2003 Mar;52(3):222-7.
To describe the management of after-hours calls to primary care physicians and identify potential errors that might delay evaluation and treatment.
Survey of primary care practices and audit of after-hours phone calls. Ninety-one primary care offices (family medicine, internal medicine, obstetrics, and pediatrics) were surveyed in October and November 2001. Data collected included number of persons answering the calls, information requested, instructions to patients, who decided whether to contact the on-call physician, and subsequent handling of all calls. We evaluated all after-hours calls to an index office that were not forwarded to the on-call physician. Four family physicians independently reviewed the calls while unaware that these calls had not been forwarded to the physician on call to determine the appropriate triage.
Primary care physicians and their telephone answering services. OUTCOME MEASURES (1) Who decided to initiate immediate contact with the physician? (2) Percentage of calls identified as emergent or nonemergent by patients. (3) Independent physician ratings of nonemergent calls.
More than two thirds of the offices used answering services to take their calls. Ninety-three percent of the practices required the patient to decide whether the problem was emergent enough to require immediate notification of the on-call physician. Physician reviewers reported that 50% (range, 22%-77%) of the calls not forwarded to the on-call physician represented an emergency needing immediate contact with the physician.
After-hours call systems in most primary care offices impose barriers that may delay care. All clinical patient calls should be sent to appropriately trained medical personnel for triage decisions. We urge all clinicians that use an answering service to examine their policies and procedures for possible sources of medical error.
描述基层医疗医生夜间电话的管理情况，并识别可能延误评估和治疗的潜在错误。
对基层医疗实践进行调查并对夜间电话进行审计。2001年10月和11月对91个基层医疗办公室（家庭医学、内科、妇产科和儿科）进行了调查。收集的数据包括接听电话的人员数量、所要求的信息、给患者的指示、决定是否联系值班医生的人员以及所有电话的后续处理情况。我们评估了打给一个索引办公室的所有未转接给值班医生的夜间电话。四名家庭医生在不知道这些电话未转接给值班医生的情况下独立审查这些电话，以确定适当的分诊。
基层医疗医生及其电话应答服务。
（1）谁决定立即联系医生？（2）患者将电话识别为紧急或非紧急的百分比。（3）医生对非紧急电话的独立评级。
超过三分之二的办公室使用应答服务接听电话。93%的医疗机构要求患者决定问题是否紧急到需要立即通知值班医生。医生审查人员报告说，未转接给值班医生的电话中有50%（范围为22%-77%）代表需要立即联系医生的紧急情况。
大多数基层医疗办公室的夜间电话系统设置了可能延误治疗的障碍。所有临床患者电话都应转交给经过适当培训的医务人员进行分诊决策。我们敦促所有使用应答服务的临床医生检查其政策和程序，以查找可能的医疗错误来源。
