Background: Our large academic medical center has no standardized paging process. Communication between nurses and internal medicine (IM) providers occurs through an alphanumeric one-way paging system. The majority of the pages are non-urgent and often only include a call back number. Non-urgent pages can cause provider fatigue, particularly during high volume messages. Additionally, unclear text result on delayed provider response time and nursing frustration. There is limited literature on nurse perceptions of provider call back time and clarity of pages.
Purpose: The goals of this quality improvement project were to improve nurse and IM provider communication satisfaction and reduce call back time by introducing a priority-based messaging process.
Description: Pre intervention surveys were sent via Research Electronic Data Capture (REDCap) link to 163 nurses and 125 IM providers. We adopted a priority-based paging process with permission from the University of Virginia Health System which has nurses classify all pages into one of four categories of ascending priority: FYI, NEEDS ACTION, COME NOW, or URGENT.FYI conveys non-urgent information and does not required a call back. Needs Action requires a response within 15-30 minutes. Urgent requires a response within 5 minutes, and Come Now is an emergency. All text require sender’s role, patient’s name, medical record number, location, brief summary of what is being requested using SBAR (Situation, Background, Assessment, and Recommendation) if appropriate, and call back number. We conducted educational sessions on the paging process during staff meetings, huddles, and provider conferences. During the implementation phase, education was reinforced with badge sized laminated cards to remind them of the paging process. After a four month period, pre-survey completers received a post-implementation survey to assess improvement of the paging process. No identifiable data was collected.
Conclusions: Pre and post intervention surveys were completed by 42 (26%) nurses and 15 (12%) providers. The provider results in regards to satisfaction with the current paging system were unchanged from pre to post intervention (67%). However, satisfaction with clarity of pages from the ER was increased from 20% to 40% after the intervention.Nurses reported increased satisfaction with the paging process from 30% to 72% post intervention (p < .001 from paired t-test). Also, nursing perception of provider call back time decreased by 7.7 minutes, 20 minutes pre vs 12.3 minutes post intervention (p < .001). Provider perception of call back time was unchanged (7 vs 6 minutes).Soon after this QI project was completed, the hospital adopted a HIPPA compliant instant messaging application called TigerConnect. Our goal is to implement the priority-based messaging to this new method of communication and use the same metrics to determine improvement in communication.