Analysis of after-hours patient telephone calls in two academic radiation oncology departments: An opportunity for improvement in patient safety and quality of care

Abstract

QUESTIONASKED: Howoften and for what reasons do patients call the on-call radiation oncologist outside of normal business hours? SUMMARY ANSWER: During 5,600 courses of radiation delivered over the study time period, only a small minority of patients (7%) called a radiation oncologist after hours; however, calls from patients with certain primary cancers, including head and neck and gynecologic malignancy, represented a greater proportion of total calls received relative to total patients treated (Fig 1; P,.05). The reasons prompting the telephone calls were classified into eight themes: acute medical issue not related to radiotherapy (32% of calls), acute adverse effect related to radiotherapy (28%), medication management including refills (14%), appointment scheduling (5%), nonurgent medical concerns (6%), acute medical issue of unclear etiology (4%), imaging or procedure preparation (4%), and late radiotherapy-related side effects (1%). METHODS: Patient calls received outside of business hours during one academic year at two academic radiation oncology departments were retrospectively reviewed and analyzed using content analysis and descriptive analyses. BIAS, CONFOUNDING FACTOR(S), DRAWBACKS: Only 50% of the telephone calls were documented by the responding clinician in the electronic medical record, perhaps because the study was performed retrospectively, during a time with no explicit departmental expectations regarding documentation about patient telephone calls. Also, while this is a comprehensive review of after-hours telephone calls received by two radiation oncology departments, it may not represent all after-hours contact radiation oncology patients had with any provider during the study time period. REAL-LIFE IMPLICATIONS: A comprehensive review of after-hours telephone calls provided unique information about the volume of and issues prompting phone calls from patients to on-call radiation oncologists outside of normal business hours.While an on-call physician should be available to answer questions after hours, this analysis prompts several questions, includingwhich of these issues could be better addressed by the primary radiation or medical oncology team during business hours. For example, 14% of patient calls in our series were about medication management, but published data have demonstrated that having more physicians prescribing medication for an individual patient significantly increases the risk of potentially inappropriate drug combinations. This analysis has compelled a departmental effort to remind patients to ask questions about and request refills of theirmedications during normal business hours. This analysis also identified patient education about common side effects of radiation therapy and communication between oncall providers and the primary oncology team as opportunities for improvement. All oncology practices could relatively easily undertake a similar study to better understand the needs of their patient population as a quality improvement initiative.