After-Hours Calls from Long-Term Care Facilities in a Geriatric Medicine Training Program

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Abstract
To describe after-hours telephone calls from nurses in long-term care (LTC) facilities to doctors in a geriatric medicine training program. Evaluation of 1,928 after-hours calls from LTC facilities over a 10-month period in 2005/06. Geriatrics fellowship program and three affiliated LTC facilities. Eight geriatrics fellows and 40 medicine interns. Data were collected on call characteristics (such as reason for call and call outcome) and physician attitudes about the call, scored using a 5-point Likert scale. Clinical problems were the focus of 70.4% of the calls. The range of clinical problems was broad; most common reasons for calls were falls (n=377), pain (n=138), and agitation (n=100). The majority of calls resulted in medical intervention, including new medications or treatments (43.4%), diagnostic tests (10.2%), or more-extensive medical evaluation in the emergency department (9.1%) or by an on-site physician (2.4%). Overall, physician trainees had favorable attitudes about most after-hours calls, although medicine interns taking calls had a less-favorable impression and felt less prepared to manage them. After-hours telephone calls from LTC facilities are common, reflect the heterogeneity of geriatric health concerns, and typically result in intervention. As the LTC population grows, more study is needed on telephone care and optimal strategies for training physicians in this important aspect of LTC.