Background:
Hospital communication is an integral component of clinical care but is often inefficient and error‐prone. Specifically, sending and receiving pages is a burdensome process involving significant time that later must still be conveyed to other providers in the form of additional communications or progress notes.
Purpose:
Our goal was to target pager burden, improve hospital efficiency, and improve inpatient interdisciplinary communication by improving paging communication.
Description:
We conducted a needs assessment in March 2013 showing that 43% of 101 physician and nurse survey participants felt that paging was a burden, while 75% reported that they knew of an error, adverse event, or near‐miss that occurred as a result of errors in paging in the hospital. Two volunteers shadowing residents in the hospital found that residents spend 50% of their time on clinical communication or documentation and order‐writing. Concurrently, we were designing CareWeb Messenger (CWM), a web‐based HIPAA‐compliant paging tool that hybridizes Facebook and Twitter with text paging technology to allow users to send, receive, view, search, and store messages on a patient’s “wall” (see figure) while routing each message to a provider’s pager and wireless phone. The system can be used by any provider who is enabled as a user including nurses, physicians, pharmacists, case managers and social workers, and others, and can be used to reach any provider with a pager or phone, even if he/she is not a user. As we built the system, we solicited user input from a range of potential physician users to inform features and improve uptake. We launched the pilot in October 2013, since which 138 users have sent 4,062 pages—2,589 of these tagged to a specific patient and thus viewable on that patient’s wall. We distributed surveys to all users who had ever‐logged in (n=200); we received 62 responses (31%) so far. All respondents acknowledged using it, while 17% were using it for 80% of their paging needs. CWM was preferred to the existing paging system on a variety of measures, most especially for sharing and reviewing communication (by 65% of respondents) and overall (55%). Post‐CWM time‐and‐motion data are pending.
Conclusions:
By providing a searchable reference of all pages sent, CWM has improved the retrieval and review of clinical communications. We hope to roll the tool out to more services in this post‐pilot period and study its impact on clinical efficiency using the post‐CWM time and motion data, and on clinical outcomes such as length of stay and 30‐day readmission.
