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Abstract
Background Paging still represents an important form of communication within hospitals, but it results in interruptions, and other more modern approaches could be superior. This study aims to describe how paging is currently used in an academic medical centre, including the frequency, type, urgency and sender of pages, so that improvements in communication can be better informed.
Study sample In order to understand what communication needs paging fulfils in a modern academic medical centre, we analysed a database of 1252 pages sent to internal medicine residents within an academic medical centre. We assessed all pages from 3 separate general medicine rotations over a total of 56 days encompassing 602 h.
Results Residents were paged an average of 22.4 times per day, with a maximum of 50 pages per day. Most pages were deemed clinically relevant (76%) and important (76%) to patient care. Overall, 59% of pages required a response. A mean of 7.7 pages were sent per patient, up to a maximum of 70 pages for one patient. Nurses (28%), consultants (16%) and the clinical laboratory (15%) were responsible for the majority of pages. Almost all pages from nurses (82%) and consultants (82%) required a response. Regionalised services had significantly fewer pages per day than non-regionalised services (19 vs 37, p≤0.00001).
Conclusions Paging remains widely used for communications within hospitals about patient care. Although the majority of pages were judged to be clinically relevant and important, they frequently required a response potentially leading to interruptions in workflow, and communication waste. Paging rate and volume has not decreased in 25 years despite significant penetration of newer technologies. For the majority of current uses of pages, we believe other approaches may now be more appropriate. Regionalisation significantly reduces the number and urgency of the pages.
- Communication
- Hospital medicine
- Information technology
- Interruptions
- Teamwork
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Footnotes
Twitter Follow Narath Carlile at @narathc and David Bates at @dbatessafety
Contributors NC conceived of the study. NC, JR, and DB reviewed and contributed to the refinement of the study design. NC implemented the study with KM and CM contributing data and KM assisting with analysis. All authors contributed to the refinement of the analysis and final manuscript.
Competing interests NC reports that during the writing of the article he became Chief Medical Information Officer for Accountable Care Transactions a care coordination software company in which he holds a minor equity position. DWB reports that he is a co-inventor on Patent No. 6029138 held by Brigham and Women's Hospital on the use of decision support software for medical management, licensed to the Medicalis Corporation. He holds a minority equity position in the privately held company Medicalis which develops web-based decision support for radiology test ordering. He serves on the board for SEA Medical Systems, which makes intravenous pump technology. He is on the clinical advisory board for Zynx, which develops evidence-based algorithms. He consults for EarlySense, which makes patient safety monitoring systems. He receives equity and cash compensation from QPID, a company focused on intelligence systems for electronic health records.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement De-identified data including ratings and unique randomly generated user identifiers are available for further analysis upon request from the corresponding author.