Inter-disciplinary focus groups on telephone medicine: a quality improvement initiative.

OBJECTIVE

To identify opportunities for quality improvement in long-term care telephone medicine using a model of interdisciplinary focus groups.

DESIGN

Descriptive pilot project.

SETTING

Extended Care and Rehabilitation Center (ECRC), Durham VA Medical Center, Durham, North Carolina.

PARTICIPANTS

Eight of 20 registered or licensed practical nurses and 4 of 6 geriatric medicine fellows voluntarily participated in this quality improvement project.

MEASUREMENTS

In two 45-minute focus groups, participants were asked to discuss 3 open-ended questions related to telephone medicine. Comments were recorded during the discussions; topical themes were identified by the authors.

RESULTS

Participant comments could be categorized into 4 domains describing the characteristics of nurses and physicians who practice the best telephone medicine: (1) provides the appropriate medical component of patient care; (2) appreciates contextual issues; (3) respects the other party's time and resources; and (4) possesses a collaborative attitude. The focus groups identified 5 quality improvement goals: (1) better nursing assessment and provision of patient information; (2) minimization of non-urgent calls after hours; (3) more decisive physician action (or explanation of inaction); (4) better physician familiarity with facility policies/logistics; and (5) better communication/paging system. The discussion format allowed nurses and physicians to identify and respond to potential barriers to improving quality in each area.

CONCLUSION

Nurses and physicians appreciate unique aspects of long-term care telephone medicine and identify distinct barriers to improving practice. Interdisciplinary focus groups were a productive step toward understanding the telephone medicine experience in our facility and developing quality improvement interventions for both nurses and physicians.