Improving telephone communication with patients

Physician on telephone with patientTelephone communications with physicians, pharmacists, medical staff, and patients can result in miscommunication and lead to treatment and prescription errors. Anna Reisman, MD, and Karen Brown, MD, point out in their Journal of General Internal Medicine article that telephone communication may be error-prone because of technical issues and an absence of visual cues.

Additionally, medical residents typically have little training in telephone medicine during their residency programs. Studies have found that in nearly one third of telephone communications, patients and physicians interpreted the reason for the calls differently, and patients were more likely than physicians to believe their calls were “true emergencies.”1

Despite the potential drawbacks, however, telephone communication with patients can reap large rewards—benefiting patient health and a medical facility’s bottom line. In a study of 174,120 patients reported in the New England Journal of Medicine, telephone management of patient care resulted in a 4.4% reduction of health care expenses—due, to the most part, from a reduction in inpatient and outpatient hospital expenses. More important, patients with chronic conditions and other high-risk conditions had “significantly fewer admissions.”2

So knowing that good telephone care can improve patient health—particularly for those with chronic and other serious conditions—what are some ways to improve phone communication and increase patient safety?

  1. Do not assume that a person on the telephone understands you. For any call, ask that all your instructions be repeated back to you.
  2. Some conditions may require extra care. Consider spending extra time and repeating your advice if the patient is experiencing abdominal or chest pain, high fever for more than 24 hours, fever of unknown origin, convulsions, vaginal bleeding, head injury, dyspnea, a cast feeling too tight or producing abnormal discomfort, visual alterations, or the onset of labor.
  3. Be sure that nonphysician staff members understand the dangers of routine prescription approval by phone, even if the patient is well known to them. Develop an office protocol to regulate the telephone prescription refills that nonphysician staff members handle.
  4. Consider implementing a call-back program to improve patient relations and identify patient care problems. A day or two after a visit, a physician or physician aide can telephone postoperative patients, anxious patients, new patients, and regular patients on new medications or with new medical problems. The caller can ask patients how they are feeling, if they are taking their medication, if they have questions about the physician’s instructions, if they have scheduled a follow-up appointment, etc., and then enter the answers into the medical record. Most patients appreciate the concern and the opportunity to clarify instructions.
  5. Do not discuss the patient’s condition with anyone else who may answer the phone unless you have authorization to do so. If the patient is not available, it’s best to say, “I’m calling to talk with Phyllis. Please ask her to call us back today.”
  6. Document phone calls to patients when you report test results, advise the patient to return or seek further medical attention, ask the patient to take a specific action, give medical advice, obtain history, or know that the patient is anxious.
  7. Document calls to consultants that you contact for advice about a specific patient.
  8. To reduce the risk of medication errors resulting from verbal miscommunication, the ECRI Institute recommends including the following elements in each verbal medication order: date; time; patient name; drug name (brand or generic); dosage form (tablets, inhalants, etc.); strength of concentration; dose, frequency, and route; quantity; duration; prescriber name; and the name and title of the person receiving the order.3

 

1. Anna Reisman and Karen Brown, “Preventing Communication Errors in Telephone Medicine,” Journal of General Internal Medicine 20 (2005): 959-963, doi: 10.1111/j.1525-1497.2005.0199.x.
2. David Wennberg, Amy Marr, Lance Lang, Stephen O’Malley, and George Bennett, “A Randomized Trial of a Telephone Care-Management Strategy,” New England Journal of Medicine 363 (2010): 1245-1255, doi: 10.1056/NEJMsa0902321.
3. ECRI Institute, “Verbal/Telephone Orders,” Healthcare Risk Control, https://members2.ecri.org/Components/HRC/Pages/RiskQualPol17.aspx, accessed June 26, 2014.

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