Raines Amanda, Ahn Jennifer, Cain Mark, Fernandez Nicolas, Joyner Byron, Kieran Kathleen, Shnorhavorian Margarett, Merguerian Paul
Division of Pediatric Urology, Seattle Children's Hospital, Seattle, WA, USA; Department of Urology, University of Washington, Seattle, WA, USA.
Division of Pediatric Urology, Seattle Children's Hospital, Seattle, WA, USA; Department of Urology, University of Washington, Seattle, WA, USA.
J Pediatr Urol. 2023 Oct;19(5):539.e1-539.e7. doi: 10.1016/j.jpurol.2023.06.026. Epub 2023 Jul 4.
Caregiver phone calls are an important part of caring for pediatric patients. At our institution, residents respond to after-hours caregiver calls. While it is critical for families to be able to reach us for urgent concerns, the ease of access has led to overutilization with many phone calls not meeting the urgent nature that is intended for these calls. The primary aim of this quality improvement project was to decrease the number of non-urgent caregiver calls after-hours. Our secondary aim was to improve compliance with telephone encounter documentation and to standardize the documentation content.
We conducted a single institution, multiphase quality improvement project. This started with a preintervention phase which included evaluation of our current state, identifying that most calls were for post-operative patients and that our discharge instructions inadequately detailed when caregivers should call. Notes were also inconsistently documented with no standard format. In the first PDSA cycle, launched on November 1, 2021, a standardized note template was created for documentation of caregiver telephone encounters. The PDSA cycle began on January 1, 2022 and included updates to our post-operative instructions with explicit guidance detailing when to call after-hours. Call data from September 2021 to February 2022 was reviewed including variables such as caller demographics, reason for call, and operative details. Primary outcomes were proportion of post-operative calls within 30 days and non-urgent calls. Secondary outcome was proportion of calls documented appropriately. Phases were categorized as current state (Sep/Oct 2021), PDSA cycle 1 (Nov/Dec 2021), PDSA cycle 2 (Jan/Feb 2022).
In our current state, the majority of the calls (66%) were for post-operative patients and 59% of all calls during this period were non-urgent. The proportion of post-operative phone calls stayed stable at 67% during PDSA cycle 1, but decreased to 38% with PDSA cycle 2 with implementation of updated post-operative instructions (Summary figure) (p < 0.001). The proportion of non-urgent calls was similar (current state - 68%, PDSA cycle 1 - 72%, PDSA cycle 2-73%, p = 0.39) (Summary figure). Call documentation was also similar with a documentation rate of 79% pre-intervention and 87% post-intervention (p = 0.21) (Summary figure).
With interventions focused on post-operative caregiver instructions, the number of post-operative phone calls decreased. Standardization of documentation was achieved. However, the overall call volume did not change, nor the proportion of non-urgent calls.
照顾者来电是儿科患者护理工作的重要组成部分。在我们机构，住院医师负责接听非工作时间照顾者的来电。虽然让家属能够就紧急问题联系到我们至关重要，但便捷的联系方式导致了过度使用，许多来电并不符合此类电话应有的紧急性质。这个质量改进项目的主要目标是减少非工作时间非紧急的照顾者来电数量。我们的次要目标是提高电话问诊记录的合规性并使记录内容标准化。
我们开展了一项单机构多阶段质量改进项目。项目始于干预前阶段，包括对当前状况的评估，发现大多数来电是关于术后患者的，且我们的出院指导未充分详细说明照顾者何时应该致电。记录也不一致，没有标准格式。在2021年11月1日启动的第一个计划 - 实施 - 研究 - 改进（PDSA）循环中，创建了一个标准化的记录模板用于记录照顾者电话问诊情况。PDSA循环于2022年1月1日开始，包括更新我们的术后指导，明确详细说明了非工作时间何时致电。对2021年9月至2022年2月的来电数据进行了审查，包括来电者人口统计学信息、来电原因和手术细节等变量。主要结果是术后30天内来电的比例和非紧急来电比例。次要结果是记录恰当的来电比例。各阶段分为当前状态（2021年9月/10月）、PDSA循环1（2021年11月/12月）、PDSA循环2（2022年1月/2月）。
在当前状态下，大多数来电（66%）是关于术后患者的，在此期间所有来电中有59%是非紧急的。在PDSA循环1期间，术后电话来电比例稳定在67%，但在PDSA循环实施更新后的术后指导后降至38%（汇总图）（p < 0.001）。非紧急来电比例相似（当前状态 - 68%，PDSA循环1 - 72%，PDSA循环2 - 73%，p = 0.39）（汇总图）。电话记录情况也相似，干预前记录率为79%，干预后为87%（p = 0.21）（汇总图）。
通过针对术后照顾者指导的干预措施，术后电话来电数量减少。实现了记录的标准化。然而，总体来电数量没有变化，非紧急来电比例也没有变化。
