Nurse attention to phone-call consultations in a heart failure unit

Abstract

Introduction: Education and global clinical assessment of a patient situation are paramount tasks of nurses in a Heart Failure Unit. These tasks are mostly performed during clinical visits with face-to-face patient evaluation, counselling, and education. However, phone calls and phone consultations have became a progressively more common parallel task of nurses that need to be performed along with the routine job of clinical visits. Objective: To analyse the main causes of phone consultation and the answer delivered or the action taken in a Heart Failure unit that attends an outpatient heart failure population. Results: Between February and November 2012, 716 calls have been recorded. In 56% of cases the patient itself performed the call whereas in the remaining 44% the call was done by a carer, usually a family carer. The main reason for calling was a consult about non-heart failure treatment (23.5%), followed by questions about heart failure treatment (23.7%) and request of change of date of visit (19.7%). Remarkably, worsening of heart failure symptoms represented only a 10.2% of phone consultations. Fatigue (43.3%) and oedemas (38.3%) were more frequent than dyspnoea (24.6%) and sudden weight gain (16.4%) as a cause of these consultations. Forty-eight percent of calls related to heart failure treatment were consequence of secondary hypotension. Median duration of calls was 2 minutes. In 52%% of consultations the action taken was just to give an advice (including some times a visit to General Practitioner), whereas treatment was changed in 11.2% of cases. In a 12.8% of cases the patient was asked to come to the Unit for a personal visit and in only 10.6% the phone call was redirected to the doctor. Conclusion: The main cause of phone consultation in a multidisciplinary heart failure unit was not worsening of heart failure symptoms but consultations about non-heart failure treatment, usually prescribed by General Practitioner or other specialists. Nurses only redirected one of every ten phone calls to heart failure doctors.