Fowkes W, Christenson D, McKay D
Stanford University Medical School, California, USA.
J Am Geriatr Soc. 1997 Jan;45(1):67-70. doi: 10.1111/j.1532-5415.1997.tb00980.x.
To characterize the nature of telephone communication in the care of patients in skilled nursing facilities, noting numbers of calls, reasons for communication, and the outcomes of the interactions, and to implement a voice mail system to manage the burden of communication more effectively and describe the impact of this system.
An archival descriptive study of phone message data covering a period of 1 year in a defined population of nursing home patients, with an intervention and an evaluation of a voice mail system at the conclusion of the year's study.
A long-term care practice associated with an urban family practice residency program.
Medical care providers, the staffs of 13 skilled nursing facilities, and an average of 207 covered patients followed for 1 year.
At the termination of the descriptive study, a voice mail system was instituted, and the impact on phone communication was documented.
Total numbers of calls were tabulated by patient and by facility. Reasons for calls, outcomes, and timing were tabulated. The impact of a voice mail system on the communication between nursing home staff and medical providers was characterized.
A total of 10,264 calls were received from 13 skilled nursing facilities in regard to an average of 207 continuously covered long-term care patients, which is an average of nearly 50 calls per patient per year. Acute illness accounted for only 5% of calls, and most communications were routine. Though a new treatment was instituted about one-third of the time, no new order was issued in response to 23% of received calls. Hospitalization occurred as the result of about one in two hundred calls. A recent tabulation of 692 calls received during 1 month revealed that 93% of calls are now received through voice mail and about one in five of these calls do not need to be returned.
There is a significant telephone call burden associated with care of patients in skilled nursing facilities. Most of these calls are routine, regulation driven, and often no return call is necessary. For many reasons, including poor reimbursement, much of the medical care delivered occurs as a result of these calls, and methods of managing the communication burden to allow prioritization both by the staff nurse and the physician need to be found. In the practice described, the voice mail system is a positive step in this direction.
描述专业护理机构中患者护理过程中电话沟通的性质，记录通话次数、沟通原因及互动结果，并实施语音邮件系统以更有效地管理沟通负担并描述该系统的影响。
一项对养老院患者特定人群为期1年的电话信息数据的档案描述性研究，在该年研究结束时对语音邮件系统进行干预和评估。
与城市家庭医疗实习项目相关的长期护理机构。
医疗服务提供者、13家专业护理机构的工作人员，以及平均207名接受为期1年跟踪的参保患者。
在描述性研究结束时，设立了语音邮件系统，并记录其对电话沟通的影响。
按患者和机构列出通话总数。列出通话原因、结果和时间。描述语音邮件系统对养老院工作人员与医疗服务提供者之间沟通的影响。
从13家专业护理机构收到了共计一万零二百六十四次关于平均207名持续参保的长期护理患者的电话，平均每位患者每年近50次通话。急性疾病仅占通话的5%，且大多数沟通为常规沟通。虽然约三分之一的时间会采用新的治疗方法，但2３%的来电未得到新的医嘱。约每二百次通话中有一次会导致住院。最近对一个月内收到的692次通话的统计显示，现在93%的来电通过语音邮件接收，其中约五分之一的来电无需回复。
专业护理机构中患者护理存在显著的电话沟通负担。这些通话大多是常规的、受规定驱动的，且通常无需回电。由于多种原因，包括报销不佳，许多医疗护理是由这些通话促成的，需要找到管理沟通负担的方法，以便护士和医生都能进行优先排序。在所描述的实践中，语音邮件系统是朝着这个方向迈出的积极一步。
