A quality improvement program to enhance after-hours telephone communication between nurses and physicians in a long-term care facility.

OBJECTIVES To determine whether satisfaction of on-site nurses with after-hours telephone communication with off-site physicians improved in one long-term care (LTC) facility after a nurse-oriented intervention. DESIGN Longitudinal quality improvement study. SETTING Extended Care and Rehabilitation Center (ECRC), Durham Veterans Affairs Medical Center. PARTICIPANTS Eighteen registered nurses. INTERVENTION Communicating Health Assessments by Telephone (Project CHAT), a program of individualized training sessions and decision support tools to aid LTC nurses with symptom assessment and communication of health information over the telephone. MEASUREMENTS Nurses completed six satisfaction surveys (three surveys in the 3 months before Project CHAT and three surveys in the 3 months after Project CHAT). RESULTS The nurses' average satisfaction scores increased on several items, including those that assessed whether the nurse was pretty sure what pieces of information the physician was going to ask for (P=.04), felt that the amount of patient information the physician asked for seemed reasonable (P=.03), felt prepared to answer the questions the physician asked (P=.01), and felt that the process of gathering patient information for the physician was easy (P=.01). The percentage of calls that resulted in immediate evaluation by a physician (on-site or in the emergency department) increased from 2.0% in the period before Project CHAT to 8.6% in the period after Project CHAT (P=.01). CONCLUSION Nurses' satisfaction with several aspects of after-hours telephone medicine improved after an inexpensive, education-based intervention in one LTC facility. Further research is needed to determine how similar interventions might affect other quality measures, including patient outcomes.