Wrong phone numbers threaten patient safety
July 1, 2010 5 minutes read
Wrong phone numbers threaten patient safety
Sometimes, it is the simplest thing that can trip you up and create a liability risk, not to mention a huge hassle for your staff. The phone numbers provided by patients often turn out to be invalid, which means they cannot be contacted later when important test results or diagnoses must be conveyed.
Wrong phone numbers create problems more often than you might imagine. One report found that of 1,136 patients studied, only 42% could be contacted through the numbers they provided at admission.1 Of the patients unreachable after three attempts, 16.1% had given wrong numbers, 11.7% had disconnected lines, and 13.7% had three consecutive "no answers." Females and patients with nonurgent complaints were significantly more likely to be contacted.
Being unable to reach patients can create difficult situations when the information is crucial. Providers sometimes must send registered letters or even have the police try to track down the person.
Wrong phone numbers are a growing problem for health care providers, says Patrick Hurd, JD, senior counsel and leader of the healthcare industry group with the law firm of LeClair Ryan in Norfolk, VA. One might think that it would be easier to reach people now that so many patients have cell phones and multiple numbers, but in fact, the increased use of technology seems to make matters worse, he says.
For instance, patients sometimes use pre-paid disposable cell phones that become inoperable after a time, and many people are discontinuing the use of land-line telephones, he says. Some patients also intentionally provide wrong phone numbers in an effort to avoid payment, or because they have other motives for not revealing their true identification and contact information. Illegal immigrants may be afraid to provide valid contact information for fear that it could reveal their status.
Creates liability risk
An inability to reach the patient can create significant liability issues for the provider, Hurd says. Lawsuits can result if the patient sustains harm because the provider did not convey important information, and then the question will be whether the provider did enough to try to make contact. If important test results come back, and the patient cannot be reached by telephone, the provider is still obligated to try to contact the patient by other means, Hurd says. That may mean by sending the patient a letter, sending a patient liaison to the person's home, or in the most serious cases, even asking the police to find the patient.
However, Hurd cautions that there is a limit to how much the provider is obligated to do.
"You have to make reasonable efforts on the intake side to get accurate information, so that you can avoid these problems in the first place," he says. "And if you do get a bad phone number or other information, you have to do what is reasonable to contact that person. You're not obligated to go to extreme measures in every case."
The response is determined by how vital the information is to the patient's health, Hurd says. If the information indicates that the patient needs immediate treatment, the provider must go further after finding out that the phone number is incorrect, he says.
"Most of the time this happens in the emergency room," he says. "Sometimes the person leaves against medical advice or elopes, and the information you have is vital to that person's safety. Or, in other cases, it could be a public health issue, in which case you need to go the extra mile."
In the most serious cases, the provider can call the police to ask for a "safety check," in which the police will go to the address provided by the patient and notify him or her that the provider is trying to make contact and has important information. The same visit can be performed by a patient representative from the provider or a paramedic, also.
Doctors also a problem
A related problem involves physicians who give wrong numbers to the provider. Outdated call schedules, and confusion relating to the best number to call a physician during a given time of day, can delay the contact, notes Terry Edwards, the president and CEO of PerfectServe, a company in Knoxville, TN, that provides technology to help providers contact physicians more efficiently and documents contact between hospitals, physicians, and clinicians to reduce liability risks.
The volume of calls to physicians means that wrong numbers can have a serious effect on patient safety, Edwards says. Data from his company's clients indicate that a 300-bed hospital will make about 180,000 calls or other communication to physicians every year, or about 500 a day. The communications would not be so difficult if the nurse were simply able to call the doctor at the same number all the time, but in reality, the staff must keep track of a hodgepodge of numbers, time schedules, and other variables that affect who and how they should call.
"You'll have doctors who want you to call their cell phone at certain hours, but not on certain hours on certain days, and they want you to call their home number sometimes, and other times they don't want you to call them at all but to call their physician's assistant instead," he says. "And then someone wants you to page him instead of calling, because his cell service isn't so good. There's no consistency, and every doctor can do it however he wants. This is a lot for the staff to keep up with, and it leads to communication problems."
If the call is directed to the wrong number at the wrong time, the physician may not receive the call, or a response will be delayed. Even when the phone numbers are accurate, the staff can have difficulty with reaching physicians in a timely manner. Throw a couple of wrong numbers into the mix outdated phone numbers, a digit entered in error and the whole system collapses.
Pages also are a problem. One recent study found that pages sent to physicians often were misdirected.2 Researchers studied Sunnybrook Health Sciences Centre (SHSC) and the Toronto General Hospital (TGH), tertiary care academic teaching hospitals affiliated with the University of Toronto, Ontario. Physicians and nurses there can send numeric or text pages at their hospitals and rely on paper monthly call schedules to determine which physician to page. During the two-month study period, 1,409 of 10,190 pages were sent to the wrong physician, a 14% error rate. The wrong pages were typically sent during the postcall period, during evenings, and during scheduled academic half days.
The researchers found that 15% of the wrong pages were emergency pages that warranted immediate attention, and 32% were urgent pages that warranted a response within the hour. Extrapolating the study figures to an entire year's worth of pages, the researchers concluded that there are more than 4,300 incorrect pages per year at each hospital, including about 2,000 pages requiring an emergency or urgent response.
References
1. Boudreaux ED, Ary RD, St. John B, et al. Telephone contact of patients visiting a large, municipal emergency department: Can we rely on numbers given during routine registration? J Emerg Med 2000; 18(4):409-415.
2. Wong BM, Quan S, Cheung CM, et al. Frequency and clinical importance of pages sent to the wrong physician. Arch Intern Med 2009; 169:1,072-1,073.
Sources
For more information on wrong phone numbers, contact:
Patrick Hurd, JD, Senior Counsel, LeClair Ryan, Norfolk, VA. Telephone: (757) 441-8931. E-mail: [email protected].
Terry Edwards, President and CEO, Perfectserve, Knoxville, TN. Telephone: (877) 844-7728. Website: www.perfectserve.com.
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