Managing Resources in Oncological Day Hospital: The Impact of Patients Phone Calls in the Normal Daily Practice

ABSTRACT

Background: Outpatient and Day Hospital activities represent the main commitment for a Medical Oncology. Part of the relationship with outpatients is necessarily maintained by telephone. We wanted to quantify the commitment represented by managing patient calls in our daily practice. Material(s) and Method(s) From 1/1/21 to 30/6/21 we recorded the telephone movement that took place at our Oncological Day Hospital (DH). The DH activity involves 9 doctors and in 2021. 946 patients were followed for chemotherapy (CT) and 7298 courses of CT were administered. Phone calls received from 800 to 1600 were recorded by the administrative staff in a specially built database and then were routed to each doctor who proceeded to recall the patient within 24 hours. Result(s) We recorded 2901 phone calls divided according to the following arguments 757 (26.1%) concerned treatment toxicity, 622 (21.4%) symptoms related to disease, 520 (17.9%) concerned organizational issues, 466 (16.1%) were asked for explanations about prescribed therapies, 327 (11.3%) were asked for evaluation of new exams, 209 (7.2%) concerned Covid vaccines. We then analyzed the database by quantifying the number of telephone accesses for each individual patient and we noticed that, 55 patients made more than 10 phone calls, 39 patients made between 8 and 10 phone calls, 119 patients between 5 and 7 phone calls. This group of 213 patients (22.5% of the total) was responsible for 1762 phone calls (60.1%). According to the Literature, the average duration of a telephone call varies from 9 to 12 minutes, therefore the weight of the Medical activity carried out by telephone is approximately 4.4-5.8 hours daily. Furthermore, each phone call (about 29 a day), as an interruption of scheduled activities, is a potential source of distraction and therefore of error for every professionist. These data, however important, are certainly underestimated because they don't take into account the telephone calls received directly to the Physicians (mobile, instant messaging, e-mail) that were not recorded. Conclusion(s) In our Oncology Day Hospital, taking care of patient calls takes up to 4.4-5.8 hours daily and is a significant source of interruption of scheduled activities. According to our data a small group of patients is responsible for a large part of phone calls. To reduce the effort required by patient phone calls, it is necessary to early identify this subgroup and make it subject of a monitoring active program.