Development and implementation of the TrAC (Tracking After-hours Calls) database: a tool to collect longitudinal data on after-hours telephone calls in long-term care.

INTRODUCTION Effective telephone communication between long-term care (LTC) nurses and physicians is an integral part of high-quality care, yet little is known about this key aspect of LTC practice. The authors describe the development and implementation of the TrAC (Tracking After-hours Calls) system, an electronic database designed to collect longitudinal data on after-hours telephone calls from LTC facilities. DEVELOPMENT A relational database was developed to systematically record key characteristics of calls received from LTC facilities, including the date, time, location and reason for each call (new symptom/event, lab or x-ray report, verify admission orders, order clarification, other). Physicians also recorded their actions based on the call and their impression of 5 aspects of the telephone encounter. A daily report of after-hours calls was generated using the electronic call log software and delivered to patients' primary care providers and LTC facility personnel. IMPLEMENTATION Eight geriatric medicine fellows and 40 internal medicine interns participated in the initial implementation of the database. Over a 10-month period, data were collected on 2015 calls. Call reporting was sustained over time (mean calls per week 47.6, SD 8.2) and data collection was complete (<1.5% missing values). The most common reasons for calls to the physician were falls (17%) and lab or x-ray reports (11%). Overall, 75% of calls were for clinical problems. At the end of the study period, the geriatrics clinical group decided to adapt the TrAC database for continued use in routine clinical practice. CONCLUSION Use of the TrAC database was a feasible way to collect longitudinal data on telephone communication between nurses and physicians in LTC. The system can be used for the development and evaluation of quality improvement programs and as an educational tool in geriatrics training programs.

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