Monthly Summaries of Nursing Research: January 2008

Medscape Nurses 

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Favorable Attitudes to After-hours Calls from Nurses at LTC Facilities

Hastings SN, Whitson HE, White HK, et al. After-hours calls from long-term care facilities in a geriatric medicine training program. Journal of the American Geriatrics Society. 2007;55:1989-1994.

Long-term care (LTC) facilities are providing care for more residents with complex medical conditions, but most do not have a physician available at the facility around the clock. Thus, after-hours telephone calls between the LTC facility nurses and on-call physicians are often needed to provide timely and appropriate care.

Dr. Nicole S. Hastings of Duke University led a study to examine patterns in the after-hours calls made by nursing staff at 3 LTC facilities to on-call physicians. After-hours calls were determined as those taking place from 4:30 pm to 8 am on weekdays and any time on weekends and holidays. Physicians involved in the study were fellows and medical interns in a geriatric medicine training program. The geriatrics fellows received a 45-minute orientation on how to handle such calls, while the interns met with one of the LTC directors to learn about providing this type of medical coverage by telephone.

Over the 10-month study period, nurses made a total of 1928 after-hours calls. The purpose of 70% of the calls was consultation for a clinical problem, while other calls were made to report lab or x-ray results or to clarify an order. The most common clinical problems were falls (377), followed by pain (138). A majority of the calls led to some sort of medical intervention, including new medication or treatment (43%), diagnostic testing (10%), or transport to an emergency department for more extensive evaluation (9%). The geriatric fellows reported a favorable attitude toward telephone communications, although the interns reported feeling less prepared to manage such calls.

The researchers concluded that such calls are both common and of emerging importance as the number of LTC residents is expected to increase in the coming years, and that more strategies are needed to train physicians on this aspect of LTC.



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