Should patients decide if their call is an emergency?
Answering services courting disaster
If your after-hours answering service is asking patients calling in to decide whether their complaint is an emergency, are you asking for trouble? Possibly, says a Minnesota researcher who evaluated 2,835 after-hours calls to a family medicine residency office in Denver.
Of the total calls (over a year), 288 were not forwarded to the physician on call because the caller, in response to the operator's inquiry, said their complaint was not an emergency.
Included in those calls were people who had suffered fractures, kidney stones, and at least one caller who complained of chest and radiating arm pain (who was later admitted with a gastrointestinal diagnosis).
Of calls that were not forwarded, says David Hildebrandt, PhD, of the department of family medicine at the University of Minnesota:
- 51% came into the office for an appointment;
- 4% went to the emergency room; and
- 2% were hospitalized within two weeks of the call.
Hildebrandt reports that 3% of the callers suffered harm due to their calls not being put through to the on-call physician; 26% experienced discomfort due to the delay.
"Although the level of harm is generally temporary and minimal, the potential exists for serious harm to occur," Hildebrandt wrote in the Journal of the American Board of Family Medicine.1
As in most metropolitan areas, most of Denver's primary care offices use an answering service, and 93% of those services required the patients calling in to "self-diagnose" whether their complaint amounted to an emergency.
"Although this study did not find any case of severe harm, the potential exists for serious harm and death, as in the case of the patient who called with chest pain," Hildebrandt concludes.
Reference
- Hildebrandt D. Physicians need to re-evaluate the way they handle after-hours calls. J Am Board Fam Med 2006; 19:437–442.
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