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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. [Copyright &y& Elsevier]

Objective: To identify opportunities for quality improvement in long-term care telephone medicine using a model of interdisciplinary focus groups. Design: Descriptive pilot project. Setting: Extended Care and Rehabilitation Center (ECRC), Durham VA Medical Center, Durham, North Carolina. Participants: Eight of 20 registered or licensed practical nurses and 4 of 6 geriatric medicine fellows voluntarily participated in this quality improvement project. Measurements: In two 45-minute focus groups, participants were asked to discuss 3 open-ended questions related to telephone medicine. Comments were recorded during the discussions; topical themes were identified by the authors. Results: Participant comments could be categorized into 4 domains describing the characteristics of nurses and physicians who practice the best telephone medicine: (1) provides the appropriate medical component of patient care; (2) appreciates contextual issues; (3) respects the other party’s time and resources; and (4) possesses a collaborative attitude. The focus groups identified 5 quality improvement goals: (1) better nursing assessment and provision of patient information; (2) minimization of nonurgent calls after hours; (3) more decisive physician action (or explanation of inaction); (4) better physician familiarity with facility policies/logistics; and (5) better communication/paging system. The discussion format allowed nurses and physicians to identify and respond to potential barriers to improving quality in each area. Conclusion: Nurses and physicians appreciate unique aspects of long-term care telephone medicine and identify distinct barriers to improving practice. Interdisciplinary focus groups were a productive step toward understanding the telephone medicine experience in our facility and developing quality improvement interventions for both nurses and physicians. [Copyright &y& Elsevier]