Research Activities, January 2014
Telephone communication between poison control centers and emergency departments fraught with problems
Patient Safety and Quality of Care
In 2010 alone, there were 2,384,825 consultations by U.S. poison control centers to manage poison exposures. The telephone is a critical method of communication and information transfer between poison control centers (PCCs) and emergency departments (EDs). Each PCC and ED maintains their own electronic health record (EHR) system. However, data from those systems is not electronically shared to augment or replace telephone communication.
A new study of telephone-based communication between PCCs and EDs found numerous inefficiencies, safety vulnerabilities, and ambiguous communication of information. Telephone transcripts were reviewed on a random sample of 120 PCC cases occurring during 1 year. All involved one PCC and multiple collaborating tertiary care EDs.
A list of observed phenomena was developed and categorized into concept categories. These included occurrences such as ambiguous communication of information, clinical information exchanged with non-clinical ED staff, and others. According to the study's findings, communication between the ED and PCC consists of three phases.
The first phase, notification, is when the PCC refers a patient to the ED for evaluation. The second phase is collaborative care. This begins when the patient arrives at the ED. During this phase, complex dialogues regarding diagnosis and treatment are exchanged over the phone. The final phase is ongoing consultation.
Several communication problems were identified. In 55 percent of the cases, the patient was discharged before collaboration between the ED care provider and the PCC. There was vague communication of clinical observations in 42 cases. Ambiguous communication of information concerning tests and vital signs was found in 22 percent of the cases. In some cases PCC specialists were unable to reach ED care providers, with calls routed through multiple ED staff before reaching the appropriate care provider. Clinical information was also exchanged with non-clinical staff.
Given these problems, the researchers suggest that other communication modes be considered, such as a process that partially replaces telephone communication with asynchronous, electronic health information exchange of patient and poisoning information. The study was supported by AHRQ (HS18773).
See "Inefficiencies and vulnerabilities of telephone-based communication between U.S. poison control centers and emergency departments," by Mollie R. Cummins, Ph.D., R.N., Barbara Crouch, Pharm.D., M.S.P.H., Per Gesteland, M.D., M.Sc., and others in the June 2013 Clinical Toxicology 51, pp. 435-443.