Evaluation of an Asynchronous Physician Voicemail Sign-out for Emergency Department Admissions

Received 19 November 2008; received in revised form 16 January 2009; accepted 30 January 2009. published online 13 March 2009.

Refers to article:

The Medium Is the Message: Communication and Power in Sign-outs , 13 April 2009
Alexandra G. Murphy, Robert L. Wears
Annals of Emergency Medicine
September 2009 (Vol. 54, Issue 3, Pages 379-380)
Full Text | Full-Text PDF (112 KB)

Study objective

Communication failures contribute to errors in the transfer of patients from the emergency department (ED) to inpatient medicine units. Oral (synchronous) communication has numerous benefits but is costly and time consuming. Taped (asynchronous) communication may be more reliable and efficient but lacks interaction. We evaluate a new asynchronous physician-physician sign-out compared with the traditional synchronous sign-out.

Methods

A voicemail-based, semistructured sign-out for routine ED admissions to internal medicine was implemented in October 2007 at an urban, academic medical center. Outcomes were obtained by pre- and postintervention surveys of ED and internal medicine house staff, physician assistants, and hospitalist attending physicians and by examination of access logs and administrative data. Outcome measures included utilization; physician perceptions of ease, accuracy, content, interaction, and errors; and rate of transfers to the ICU from the floor within 24 hours of ED admission. Results were analyzed both quantitatively and qualitatively with standard qualitative analytic techniques.

Results

During September to October 2008 (1 year postintervention), voicemails were recorded about 90.3% of medicine admissions; 69.7% of these were accessed at least once by admitting physicians. The median length of each sign-out was 2.6 minutes (interquartile range 1.9 to 3.5). We received 117 of 197 responses (59%) to the preintervention survey and 113 of 206 responses (55%) to the postintervention survey. A total of 73 of 101 (72%) respondents reported dictated sign-out was easier than oral sign-out and 43 of 101 (43%) reported it was more accurate. However, 70 of 101 (69%) reported that interaction among participants was worse. There was no change in the rate of ICU transfer within 24 hours of admission from the ED in April to June 2007 (65/6,147; 1.1%) versus April to June 2008 (70/6,263; 1.1%); difference of 0%, 95% confidence interval –0.4% to 0.3%. The proportion of internists reporting at least 1 perceived adverse event relating to transfer from the ED decreased a nonsignificant 10% after the intervention (95% confidence interval –27% to 6%), from 44% preintervention (32/72) to 34% postintervention (23/67).

Conclusion

Voicemail sign-out for ED–internal medicine communication was easier than oral sign-out without any change in early ICU transfers or the perception of major adverse events. However, interaction among participants was reduced. Voicemail sign-out may be an efficient means of improving sign-out communication for stable ED admissions.

a Center for Outcomes Research and Evaluation, Yale–New Haven Hospital, New Haven, CT

b Hospitalist Service, Yale–New Haven Hospital, New Haven, CT

c Section of General Internal Medicine, Department of Medicine, Yale University School of Medicine, New Haven, CT

d Section of Emergency Medicine, Department of Surgery, Yale University School of Medicine, New Haven, CT

e Section of Geriatrics, Department of Medicine, Yale University School of Medicine, New Haven, CT

f Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA

g Department of Medicine, Harvard Medical School, Boston, MA

Address for correspondence: Leora Horwitz, MD, MHS, Section of General Internal Medicine, Yale University School of Medicine, PO Box 208093, New Haven, CT 06520-8093; 203-688-5678, fax 203-737-3306

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Supervising editor: Robert L. Wears, MD, MS

Author contributions: LIH, VP, NRS, JDS, TM, GYJ, and RGK conceived the intervention, designed the study, and selected the measures. LIH, VP, NRS, and GYJ supervised the conduct of the trial and data collection. LIH managed the data, including quality control. LIH, VP, and RGK analyzed the qualitative data; LIH analyzed the quantitative data. LIH drafted the article, and all authors contributed to its revision. LIH takes responsibility for the paper as a whole.

Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article, that might create any potential conflict of interest. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. Dr. Horwitz is supported by Yale-New Haven Hospital and by the National Center for Research Resources (NCRR). Neither Yale-New Haven Hospital nor the NCRR had any role in the design and conduct of the study; collection, management, analysis and interpretation of the data; or preparation, review and approval of the article. This publication was made possible by the CTSA grant UL1 RR024139 and KL2 RR024138 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH), and NIH roadmap for Medical Research. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of the NCRR or NIH.

Reprints not available from the authors.

Publication date: Available online March 12, 2009.

PII: S0196-0644(09)00117-6

doi:10.1016/j.annemergmed.2009.01.034

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