Better Etiquette for Effective Paging (B.E.E.P.)—Improving Daily In-hospital Communications in the Pediatric ICU

Abstract

Introduction: Paging is a vital part of patient care that allows quick contact between physicians and other hospital personnel. There was no structured way to send a page to physicians at our institution. We hypothesized that by standardizing paging format, scheduling laboratory draw times, and using order clean-up sheets, through a bundle of interventions called Better Etiquette for Effective Paging, we would decrease the number of pages received on the pediatric intensive care unit (PICU) resident pager by 15%. Methods: This project was a quality improvement initiative in a 25-bed multidisciplinary PICU in a tertiary children’s hospital. Baseline data collection was performed in December 2015, categorized by time of day received and type of page. Interventions were paging standards to include relevant information, scheduling laboratory draw times, and order clean-up sheets. We collected postintervention data over 3 years to monitor for sustained change. Results: The average number of pages decreased from a baseline of 4.71 pages/patient/d in 2015 to 3.70 in 2016 (21% decrease), 3.32 in 2017 (30% decrease), and 2.74 in 2018 (42% decrease). The average PRISM 3 score remained similar in all sets (2.52, 2.50, 2.10, and 2.35). The standardized mortality ratio was not adversely affected by the decrease in pages (0.58, 1.07, 1.19, and 0). Conclusion: Standardizing the format of pages and using scheduled laboratory times with order clean-up sheets has decreased the number of pages/patient/d in the PICU by 42% without adversely affecting patient care. We can continue to improve communication among the patient care team by emphasizing efficient, standardized communication using Better Etiquette for Effective Paging.

Use of pager devices in New Zealand public hospitals as a critical communication tool: Barriers & way forward

“…In 2014, a study carried out at Stanford University Hospital labelled the paging system as inefficient and unreliable, as it was not compliant with the 1996 HIPAA, which was created primarily to modernise the flow of healthcare information and stipulate how personal information maintained by the healthcare and healthcare insurance industries should be protected from fraud and theft as regulated by the Centers for Disease Control and Prevention (CDC) [ 10 , 11 , 34 , 36 ].…”

“…These characteristics of smartphone technology would enable better team worker between various components of rapid response teams (RRTs) and promise better patient outcomes [ 8 ]. However, these apparent benefits of the smartphone use for communication of healthcare information between teams do come with unintended consequences [ [9] , [10] , [11] , [12] ].…”

To the Editor: Actions More Powerful Than Words—An Impactful Approach to Overcoming Page Burden

“…Similar interventions in the pediatric ICU setting demonstrated a 42% reduction in pages per patient, improved resident well-being and nursing satisfaction, and maintained patient safety while using a text page system. 4 Implementing standardized, algorithm-based text page systems can improve the resident learning experience while decreasing page burden during inpatient rounds.…”