Background: Paging remains a dominant communication modality in academic medical centers. Prior studies have shown that paging is frequent, often interrupts workflow, and may not always be clinically necessary.1,2 However, paging also serves as a proxy for clinical concern, particularly when sent by nursing staff. Academic medical centers support learners with differing levels of experience and hire many early-career nurses who work night shifts, when paging burden is often highest. As with other early-career professionals, there is a learning curve of institutional knowledge that must be climbed. This learning curve includes paging best practices that lead to high-quality patient care based on appropriate provider-nursing communication.
Purpose: Advanced practice providers (APPs) within the Section of Hospital Medicine at Vanderbilt University Medical Center (VUMC) developed a paging education curriculum for their early-career nursing colleagues overnight. Night cross coverage of the hospital medicine services at VUMC is done by a group of APPs. Each APP covers multiple rounding teams located on multiple nursing units. Regarding the paging protocols at VUMC, an FYI page does not require callback or action, AYC requires a response within 1hr, ASAP within 10 minutes, and STAT requires immediate life-saving action. Internal data suggests that certain units, as well as certain individual nurses, use the ASAP and STAT pages inappropriately, resulting in inaccurate prioritization of patient care needs. Our aim was to educate nursing on how to communicate acute changes in patient status effectively to providers so that appropriate prioritization and timeliness of patient care may be achieved.
Description: The APP Paging Educational Curriculum has been piloted at the unit level during the early course of a night shift and done thereafter at regular intervals. These sessions are interactive with the aims of giving information and gathering feedback. Outcomes include the effect on RRTs overnight, escalations of care overnight, nursing satisfaction, and provider satisfaction. Pilot program outcomes are nursing and provider feedback on change of practice and the number of pages per unit.Limited feedback from providers and nurses who have participated in these educational sessions indicates improved collaboration, improved communication, and better quality of paging as defined by improved clarity and pertinent information included in the pages. Internal paging data does not yet show significant change in paging practice (i.e. using AYC vs ASAP) because of this intervention. This is limited by sample size and high levels of turnover related to increased hiring levels for hospital expansion. Patient-related outcomes are currently unknown but will be investigated as the intervention is expanded.
Conclusions: Given the positive signals and qualitative feedback from this pilot intervention, there is potential for improved provider-nursing communication overnight, leading to improved patient care. Efforts to improve and standardize the communication of providers and nurses who work nights, aren’t often localized together, and are still learning institutional knowledge, is necessary for improved patient care. These efforts contribute to the goal of AMCs to become high reliability organizations. Educational efforts have the benefit of face-to-face interaction and collaboration and the potential to lead to culture change of a workforce. They are also part of the tripartite mission of AMCs such as VUMC.