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Quality improvement report
Night-time communication at Stanford University Hospital: perceptions, reality and solutions
  1. Andrew Jordan Sun1,2,
  2. Libo Wang3,
  3. Minjoung Go3,
  4. Zac Eggers4,
  5. Raymond Deng5,
  6. Paul Maggio2,
  7. Lisa Shieh3
  1. 1 Department of Urology, Stanford University School of Medicine, Stanford, California, USA
  2. 2 Department of General Surgery, Stanford University School of Medicine, Stanford, California, USA
  3. 3 Department of Internal Medicine, Stanford University School of Medicine, Stanford, California, USA
  4. 4 Department of Nursing, Stanford University School of Medicine, Stanford, California, USA
  5. 5 Stanford University School of Medicine, Stanford, California, USA
  1. Correspondence to Dr Andrew Jordan Sun, Departments of General Surgery and Urology, Stanford University School of Medicine, Stanford, California 94305, USA; ajsun{at}stanford.edu

Abstract

Background Resident work hour restrictions have led to the creation of the ‘night float’ to care for the patients of multiple primary teams after hours. These residents are often inundated with acute issues in the numerous patients they cover and are less able to address non-urgent issues that arise at night. Further, non-urgent pages may contribute to physician alarm fatigue and negatively impact patient outcomes.

Objective To delineate the burden of non-urgent paging at night and propose solutions.

Methods We performed a resident review and categorisation of 1820 pages to night floats between September 2014 and December 2014. Both attending and nursing review of 10% of pages was done and compared.

Results Of reviewed pages, 62.1% were urgent and 27.7% were non-urgent. Attending review of random page samples correlated well with resident review. Common reasons for non-urgent pages were non-urgent patient status updates, low-priority order requests and non-critical lab values.

Conclusions A significant number of non-urgent pages are sent at night. These pages likely distract from acute issues that arise at night and place an unnecessary burden on night floats. Both behavioural and systemic adjustments are needed to address this issue. Possible interventions include integrating low-priority messaging into the electronic health record system and use of charge nurses to help determine urgency of issues and batch non-urgent pages.

  • communication
  • duty hours/work hours
  • graduate medical education
  • quality improvement

https://doi.org/10.1136/bmjqs-2017-006727

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    Footnotes

    • Contributors AJS, study design, data gathering, data analysis, manuscript writing, survey design/administration. LW, data gathering, data analysis, manuscript writing, survey design/administration. MG, data analysis, manuscript writing, survey design/administration. ZE, data analysis, survey design/administration. RD, data analysis, statistical work. PM and LS, study design, data analysis, manuscript revision.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement We have two internal institutional surveys referenced in our manuscript. These are located on the Stanford intranet and are available to the authors of the paper at any time. We have used these data only to supplement the findings of our paper, not as the primary conclusions. The nursing survey done for the purpose of this study has the complete results included in table 4.