Grants and Contracts Details
Description
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.
Status | Finished |
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Effective start/end date | 6/1/07 → 5/31/09 |
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