Background: Despite advances in communication technology, alphanumeric paging remains a mainstay of hospital communication. High paging volume can lead to disruptions in clinical work. In this study, we sought to evaluate both the frequency and the content of paging messages from nurses to physicians. We subsequently implemented interventions aimed at decreasing unnecessary pages.
Methods: Our study site is a 265-bed hospital within an academic medical system. The hospitalist service is comprised of both a teaching and direct care service. We collected data on pages received by night hospitalists on the direct care service over a four week period (April – May 2014). Paging content was obtained from automated reports from the electronic pager system. We asked hospitalists to comment on any response to the pages, such as evaluating a patient or changing medication orders. Patient information was de-identified. The frequency and content of pages received were stratified into several categories. Two independent reviewers verified the categorization of each of these pages.
In the second phase of our study, a number of interventions were implemented for both nursing staff and physicians with the aim of reducing unnecessary pages. Nurses were provided with guidelines to help discern between urgent and non-urgent medical issues. Physicians were given weekly email reminders to assign themselves as members of the patient care team in the electronic medical record, order appropriate “as needed” medications and update nurses on patient care plans. Data was again recorded over a four week period (June – July 2014).
Results: A total of 708 pages were collected over the initial study period. The average number of pages per night was 25 with a standard deviation of 10 pages per night. Thirteen percent of the total pages were regarding new patient admissions to the hospital from the emergency room. Eight percent of the pages were from other physicians providing updates on patients or providing consultant recommendations. The remaining approximately 80% of pages were received from nursing staff. Of these, the majority (41%) relayed status changes in vital signs, lab abnormalities, telemetry findings or new symptoms. Of these pages, 31% did not require any intervention by the night hospitalist. Other reasons for nurses to page the night hospitalist were requests for medications (20%), to clarify prior physician orders (14%), and to evaluate patients at the bedside (9%).
During the intervention period, a total of 602 pages were collected over the study period. There was a 12.5% decrease in the number of pages regarding updates on the patient’s status, and a 60% decrease in the number of pages directed towards the incorrect physician. However, there was no statistically significant difference in the average number of nightly pages between the intervention period and pre-intervention period.
Conclusions: The primary goal of this study was to evaluate paging content directed to hospitalists in an effort to minimize interruptions in patient care and improve workflow for both nurses and physicians. We found that the majority of hospital communications overnight were initiated by nursing staff. Therefore, we implemented interventions to educate nurses and physicians on issues that resulted in unnecessary pages. These interventions resulted in a decrease in some types of pages but were not associated with significant change in the average number of pages to the on-call physician.