Are Patients' Needs Being Met After Hours? An Evaluation Of Phone Calls Made After Hours For Patients With Thoracic Malignancies.

46 Background: Understanding phone calls patients make after hours is important as it represents opportunities to provide improved care. Furthermore, better understanding of after-hours calls can help to influence reductions in healthcare spending. Therefore, we sought to evaluate the nature of after-hours calls to the thoracic oncology clinic.The study is a retrospective analysis of 4 months of phone calls made to the Stanford Cancer Institute during weekends and hours of 5pm-8am on weekdays. On-call physicians documented complaint, age, gender, and advice given. Phone calls were excluded from analysis if there were missing information. Differences in proportions were analyzed by Fisher's exact test. A two-sided p value <0.05 was considered significant.There were 271 phone calls made after-hours by patients with lung cancer however after exclusions, there were 215 calls for analysis. The majority of phone calls occurred between 5pm-11pm (n = 57; 173%) followed by daytime calls during the weekend (n = 37; 17%). A majority of phone calls were made by the patient (50%) with a slightly lower proportion made by family members (46%). The majority of patients who called were in their 50's (29%) and female (54%). A high proportion of patients called for more than one complaint (30%) although almost all patients complained of more than one symptom on review of systems (95%). The main symptoms patients called for were cough (28%) and shortness of breath (27%). Of the phone calls, 62% (133) were referred to the emergency room. Of those patients referred to the emergency department, 77% (103/133) resulted in an admission.Most after-hours phone calls from patients with lung cancer are related to symptoms. A large proportion of patients who were referred to the emergency department subsequently required an admission. Analyses of call content, and of events leading to the after hours calls might help predict hospital admission in this group of patients, and will inform development of proactive interventions to improve the quality of care, patient-centered outcomes, and value.