Patient Safety in After Hours Telephone Medicine

  • Killip, Shersten (PI)
  • Ireson, Carol (CoI)

Grants and Contracts Details


In 2004, there were almost 50 million after-hours telephone encounters between physicians and patients in the US. Errors are common in medical practice, and some studies suggest errorss may be more common in telephone medicine than in face-to-face medicine. To date, there are no studies investigating errors experienced by patients in telephone medicine. Purpose: Determine the incidence and types of errors and/or threats to patient safety which result from after hours telephone medicine. Research Questions: I) What kinds of errors are committed in after hours telephone medicine, using the International Taxonomy of Medical Errors in Primary Care (ITME-PC- Version 2) taxonomy as a framework for deriving categories? 2) What harms or potential harms do patients report and/or medical personnel recognize in patient reports of after-hours telephone medicine encounters and how do they differ? 3) What is the frequency of calls in central Kentucky that included errors which caused or had the potential to cause harm in primary care patients? Methods: This is a descriptive, qualitative study of errors and harms that occur when primary care patients call the doctor after hours. It will use interviews with patients to determine types of errors and harms that result from telephone medicine. Patients in the University of Kentucky Family Medicine Clinic (an academic health center), one rural private practice, and one urban private practice will be eligible for the study if they call their respective practice after hours. Within 3-14 days of their after hours call, they will be contacted by a research assistant who will use an interview guide to collect information about the caller and the after hours call. Six hundred interviews total will be completed. Data from the interviews will be entered into NVivo software to facilitate qualitative analysis. The reports will be analyzed for error by the PI Dr. Killip, the Co-I Dr. Ireson, and the Research Assistant. Categories of error will be derived qualitatively from the reports deemed to contain errors by the three analysts, after training by the consultant Dr. Elder. The analysis will use the ITME-PC version 2 as a framework, expanding the currently limited section of this taxonomy on after hours telephone medicine. Once categories of error have been derived, the interview reports will be coded by the three analysts. As new coding categories are added, previously coded reports will be recoded to maintain consistency throughout the duration of the study. The reports will also be coded into the existing categories of harm from the ITME-PC version 2. Frequencies of errors which caused or had the potential to cause harm will be reported as the rate of instances of harm per 100 calls. Outcomes: This project will generate the first detailed taxonomy of errors in after-hours telephone medicine, and the first large-scale report of the harms and potential harms from telephone medicine. Benefits: Knowing the types of errors and theats to patient safety in telephone medicine will enable health care systems to address this very important and previously unexplored area of patient safety.
Effective start/end date6/1/075/31/09


Explore the research topics touched on by this project. These labels are generated based on the underlying awards/grants. Together they form a unique fingerprint.