Article Figures & Data
Tables
Type of Call N % All calls received when office was closed11 4949 — After-hours calls11 nighttime and weekends 3538 71 After-hours clinical calls12* 2835 57 After-hours clinical calls not forwarded12 288 10† Final sample of clinical calls not forwarded with complete data 119 4† Patient’s suffering discomfort/harm 36 1.3† * Not appointments, billing questions, or medication refills.
† Percentage of after-hours clinical calls.
Group Clinical Calls Not Forwarded (n = 119) Age (mean) 36 Gender Male 29% Female 71% Office Visits Within 1 week 44% Within 2 weeks 7% Total 51% Emergency Department (ED) Visit within 2 weeks Any reason* 15% Related reason† 4% Hospitalized within 2 weeks Any reason* 15% Related reason† 2% Harm Clinical harm 2% At risk for future harm 1% Pain and/or discomfort 26% Interventions required 8% Emergency transport 1 patient ED visit 5 patients Office visit 2 patients Medication change 1 patient Other 2 patients * Patient visit to ED or hospital admission was for any reason.
† Patient visit to ED or hospital was related to the reason for the after-hours call.
Age and Gender Reason for Call No. of Days before Follow-up Harmed? Patient Outcome Intervention Due to Phone Call Not Being Forwarded 21 F 41 wks OB, leaking fluid 3 Moderate harm; increased future risk to patient Went to ED with “extreme worsening pain and nausea”/right pyelonephritis Emergency transport to ED 46 F Pain in chest, going down left arm Same day Patient discomfort Went to ED and admitted for medication interaction and psychological problems No intervention needed 62 M High blood sugar, doctor told him to call 1 Moderate harm; increased future risk to patient Went to office with blood sugar 497, 6 wks polyuria, polydipsia, muscle cramps in lower extremities, ketones present; no prior history of diabetes; sent to ED for fluids Emergency transport to ED 50 F Ankle injury, fell off horse yesterday Same day No change in patient status. Went to office, inability to bear weight on right ankle; distal fibular fracture, commuted, non-displaced; placed in short leg cast with walking shoe No intervention needed 16 F 8 mo OB, pelvic pain and vaginal infection for 3 mo 1 Patient discomfort Admitted to hospital; Cesarean section for acute chorioamnionitis; hospitalized for 4 days postsurgery ED visit made 56 M Please call 5 Patient inconvenience; patient discomfort Went to ED with a sore throat, urinary tract infection; medications given to treat infection ED visit made 17 M High fever 3 Patient discomfort Went to office with 3-day history of fever and chills, temperature to 103.5, x-ray shows mild right lower lobe streaky; atypical pneumonia; medications given No intervention needed 43 M Please call, health issue 1 No change in patient status Went to office, history of prostate CA 5 years ago; over past 2 years, he has been getting angry at family members and others, because of his moodiness and anger, his wife left 1 
wks ago, family worried he is depressed and suicidalNo intervention needed 27 F Chest pain, hard time breathing 2 Patient discomfort Went to office with a pre-syncopal episode; set-up for Holter monitor No intervention needed
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