Screening after-hours calls can hurt patients, study finds

Physician answering services should always direct clinical calls to doctors, authors of a new study conclude.

By Kevin B. O'Reilly, AMNews staff. Oct. 9, 2006.

A 21-year-old pregnant woman called a Denver family medicine residency clinic after business hours and reported that she was leaking fluid. When someone at the clinic's answering service asked the woman whether the matter was an emergency that should be forwarded to a physician on call, the woman demurred.

The doctor wasn't contacted, and the woman had extreme pain and nausea for three days before an ambulance took her to a hospital emergency department. There she was diagnosed and treated for pyelonephritis. Though the woman emerged relatively unscathed, the authors of a study published in the September/October Journal of the American Board of Family Medicine say she was not alone in being harmed unnecessarily.

Researchers said just 10% of the nearly 3,000 after-hours clinical calls studied were not forwarded, suggesting that using the emergency question as a screening device does not greatly reduce volume, while retaining the potential to harm patients.

"There are between 2 million and 5 million after-hours calls to physicians every year," said David Hildebrandt, PhD, lead author of the study. "If 10% don't get through to a physician, that's 200,000 to 500,000 calls with perhaps 1% of patients being harmed. In that group, some of those people are going to die."

Researchers examined a year's worth of patient calls and medical records to see what exactly was happening to patients who called after hours. From April 2000 to March 2001, 3% of patients whose clinical calls were not forwarded were seriously harmed, 26% experienced discomfort due to delay; 4% need a medication change and 1% required emergency transport to the ED.