Alphanumeric Paging: A Potential Source of Problems in Patient Care and Communication

Espino, Sasa; Cox, Diane

doi:10.1016/j.jsurg.2011.07.006

Cited by 34 publications

(20 citation statements)

References 7 publications

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“…Despite the instant, multidirectional communication platforms available today, alphanumeric paging remains a mainstay of communication between physicians and other members of the care team. Importantly, paging contributes to communication errors (eg, by failing to convey urgency, having incomplete information, or being missed entirely by coverage gaps), 2,3 and interrupts resident workflow, thereby negatively affecting work efficiency and educational activities, and adding to perceived workload. 4,5 In this era of duty hour restrictions, there has been concern that residents experience increased workload due to having fewer hours to do the same amount of work.…”

Section: Resultsmentioning

confidence: 99%

(Re)turning the pages of residency: The impact of localizing resident physicians to hospital units on paging frequency

2013

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BACKGROUND Geographic localization of physicians to patient care units may improve communication, decrease interruptions, and reduce resident workload. This study examines whether interns on geographically localized patient care units receive fewer pages than those on teams that are not. METHODS The study is a retrospective analysis of the number of pages received by interns on 5 internal medicine teams: 2 in a geographically localized model (GLM), 2 in a partial localization model (PLM), and 1 in a standard model (SM) over 1 month at New York–Presbyterian Hospital/Weill Cornell. Multivariate linear regression techniques were used to analyze the relationship between the number of pages received per intern and the type of team. RESULTS The number of pages received per intern per hour, adjusted for team census and number of admissions, was 2.2 (95% confidence interval [CI]: 2.0–2.4) in the GLM, 2.8 (95% CI: 2.6–3.0) in the PLM, and 3.9 (95% CI: 3.6–4.2) in the SM; all differences were statistically significant (P < 0.001). CONCLUSION Geographic localization of resident teams to patient care units was associated with significantly fewer pages received by interns during the day. Such patient care models may improve resident workload in part by decreasing pages, and consequently has important implications for patient safety and medical education. Journal of Hospital Medicine 2014;9:120–122. © 2013 Society of Hospital Medicine

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Section: Resultsmentioning

confidence: 99%

(Re)turning the pages of residency: The impact of localizing resident physicians to hospital units on paging frequency

2013

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“…9 10 17 18 Frequent interruptions in workflow have been linked with heightened workplace stress and an increased risk of error 23 5 6 11 13 15 18 21 22 Alpha-numeric pagers are the primary source of RN-provider communication in many healthcare institutions, and are used to convey a variety of messages 710 11 This requires the provider to stop and check each message to ensure that urgent needs (acute changes in patient condition) are addressed immediately 7…”

Section: Introductionmentioning

confidence: 99%

“…3 5 6 11 13 15 18 21 22 Alpha-numeric pagers are the primary source of RN-provider communication in many healthcare institutions, and are used to convey a variety of messages 710 11 This requires the provider to stop and check each message to ensure that urgent needs (acute changes in patient condition) are addressed immediately 710 11 17 Unfortunately, many messages are not urgent, leading to unnecessary disruptions in workflow.…”

Section: Introductionmentioning

confidence: 99%

Inbox Messaging: an effective tool for minimizing non-urgent paging related interruptions in hospital medicine provider workflow

Ferguson

Aaronson

Anuradhika

2016

BMJ Qual Improv Report

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Communication is one of the foundations on which safe, high quality care is built.1, 3, 6, 17, 20 The nature of hospital medicine requires that nurses and providers be efficient and effective in communicating with multiple disciplines.17 This need for timely communication must continually be balanced with the need to minimize interruptions in workflow.1,2 3,4,6,7,9,13,15,17,18 Interruptions not only lead to distraction, they also add inefficiency to the care process and have been shown to contribute to an increased risk of medical error.2,3,4,7,17,18 A major source of interruptions are pagers that emit an audible tone with each message received.3,9,10,17,18 This interruptive nature makes pagers a less-than-ideal tool for communicating non-urgent (address within one hour) messages received.3,9,10,17,18 In addition to increasing interruptions, pagers do not facilitate closed loop communication, another feature that has been shown to improve safety.14,17,25Inbox Messaging is intended to provide a less disruptive closed-loop method of communication for non-urgent messages.Inbox Messaging is an interface within the electronic health record (EHR) that functions similarly to e-mail. A multi-disciplinary communication workgroup identified this interface as having potential to not only decrease interruptions, but to also facilitate closed-loop communication. Inbox is currently utilized between the hours of 0700 and 1800 for non-urgent nurse-provider communication about patients on the hospital medicine service. The number of RN non-urgent pages per day was 103 (SD=19, n=97) prior to the Inbox intervention, with a significant decrease (p<.001) during follow-up to 38 (SD=14, n=354) pages per day. At the same time, the number of messages per day increased from 0 to 80 (SD=20, n=354) messages during follow-up. As desired, the mean number of RN urgent pages was unchanged from 13 per day to 13 per day (p=.52).Cerner Inbox Messaging decreases the frequency of non-urgent pager-related interruptions in workflow.

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“…In particular, outdated paging technology has been identified as the source of miscommunication and disruption in hospitals 19. Secure text messaging has been piloted as a method of preventing miscommunication through one-way pagers, reducing communication failures by up to 59% 20.…”

Section: Discussionmentioning

confidence: 99%

Waiting it out: consultation delays prolong in-patient length of stay

Rahman

Shi

Meza

et al. 2019

Postgraduate Medical Journal

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BackgroundDecreasing delays for hospitalised patients results in improved hospital efficiency, increased quality of care and decreased healthcare expenditures. Delays in subspecialty consultations and procedures can cause increased length of stay due to reasons outside of necessary medical care.ObjectiveTo quantify, describe and record reasons for delays in consultations and procedures for patients on the general medicine wards.MethodologyWe conducted weekly audits of all admitted patients on five Internal Medicine teams over 8 weeks. A survey was reviewed with attending physicians and residents on five internal medicine teams to identify patients with a delay due to consultation or procedure, quantify length of delay and record reason for delay.ResultsDuring the study period, 316 patients were reviewed and 48 were identified as experiencing a total of 53 delays due to consultations or procedures. The average delay was 1.8 days for a combined total of 83 days. Top reasons for delays included scheduling, late response to page and a busy service. The frequency in length of consult delays vary among different specialties. The highest frequency of delays was clustered in procedure-heavy specialties.ConclusionThis report highlights the importance of reviewing system barriers that lead to delayed service in hospitals. Addressing these delays could lead to reductions in length of stay for inpatients.

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Alphanumeric Paging: A Potential Source of Problems in Patient Care and Communication

Cited by 34 publications

References 7 publications

(Re)turning the pages of residency: The impact of localizing resident physicians to hospital units on paging frequency

(Re)turning the pages of residency: The impact of localizing resident physicians to hospital units on paging frequency

Inbox Messaging: an effective tool for minimizing non-urgent paging related interruptions in hospital medicine provider workflow

Waiting it out: consultation delays prolong in-patient length of stay

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