Background: Paging is a commonly used, yet limited means of communication. Despite text capability, one-way numeric paging remains the dominant method of communication at the University of Colorado Hospital (UCH). On a modified Hospital Survey on Patient Safety Culture performed on a medical floor, inefficiencies in provider to nursing communication were highlighted as an area of staff concern. Examination of this issue found that nurses had no system to communicate their level of concern, thus limiting response times to provider discretion.
Purpose: First, to develop and deploy a paging structure that numerically implied page priority across a medical specialties unit that was easy to understand, remember, and use. Second, use this paging structure to improve alignment between nurse concern and provider response time.
Description: A multidisciplinary taskforce was formed to develop a Priority Structured Paging (PSP) system whereby nurses could convey their level of urgency by tagging their page, numeric or text, with a numeric priority indicator. In the pre-intervention phase, nurses blinded to the intervention collected data, recording response time and appropriateness based on their level of concern. After 3 weeks, a pre-intervention survey was disseminated to nurses and providers by email. After a 2 week response period, the intervention phase began by informing and reminding nurses at every shift change huddle to tag sent pages with a numeric urgency indicator, and record multiple aspects of their pages as done during the pre-intervention phase. Receiving providers were educated about the different priority tiers, and were asked to record their received, tagged pages on provider intervention data recording forms. The intervention phase concluded after 2 weeks, and was followed by a nurse and provider survey. 34 nurses and 24 providers responded to the survey. Survey data demonstrated that PSP provided nurses the ability to communicate urgency when paging (p<.0000), and improved appropriate response times (p=.1350). Additional post-intervention survey data demonstrated that greater than 97% of respondents found the system to be useful, sustainable, easy to use, and easy to understand. Nurse recorded data demonstrated a 2.2 minute (p=0.45) increase in response time to low priority pages, and a 1.7 (p=0.46) and 2.1 (p=0.15) minute decrease in response time to medium and high priority pages, respectively.
Conclusions: Pagers, while limited as a communication device, can be made more effective by adopting a PSP system. Nursing adoption is critical, and is the primary reason for this pilot’s subjective success. When reviewing the survey results, user bias must be considered. Additionally, the pilot was performed on a general medical floor, limiting use of higher urgency priority tiers. Future plans include implementation on nursing units with higher acuity and increased service line diversity, and if successful, hospital-wide adoption.