Is it time to rethink how we page physicians? Understanding paging patterns in a tertiary care hospital

Abstract

BackgroundFrequent pages can disrupt workflow, interrupt patient care, and may contribute to physician burnout. We hypothesized that paging volumes followed consistent temporal trends, regardless of the medical or surgical service, reflecting systems based issues present in our hospitals.MethodsA retrospective review of the hospital paging systems for 4 services at The Ottawa Hospital was performed. Resident paging data from April 1 to July 31, 2018 were collected for services with a single primary pager number including orthopaedic surgery, general surgery, neurology, and neurosurgery. Trends in paging volume during the 4-month period were examined. Variables examined included the location of origin of the page (emergency room vs. inpatient unit), and day/time of the page.ResultsDuring the study period, 25,797 pages were received by the 4 services, averaging 211 (± Standard Deviation (SD) 12) pages per day. 19,371 (75%) pages were from in-patient hospital units, while 6426 (24%) were pages from the emergency room. The median interval between pages across all specialties was 22:30 min. Emergency room pages peaked between 16:30 and 20:00, while in-patient units peaked between 17:30 and 18:30.ConclusionsEach service experienced frequent paging with similar patterns of marked increases at specific times. This study identifies areas for future study about what the factors are that contribute to the paging patterns observed.

Ophthalmology on Call: Evaluating the Volume, Urgency, and Type of Pages Received at a Tertiary Care Center

“…The on-call otolaryngology service in Calgary, which has the same number of residents as our program, saw an average of six consults per day in 2015 [ 4 ], in comparison to our 15-16 new consults daily. Witherspoon et al looked at pages received by different services at The Ottawa Hospital [ 15 ]. Orthopedic surgery at one campus received an average of 30 pages per day, similar to our 26 pages per 24-hour period.…”

“…A significant difference in our study is that the majority (86%) of pages were new consults or direct calls from patients, and 58% led to a new patient encounter. Seventy-five percent of calls in the aforementioned study were from inpatient units [ 15 ], which often represent ward issues regarding active patients. Previous studies have shown that inpatient on-call services receive higher pager volumes during evening hours [ 7 , 15 ].…”

“…Seventy-five percent of calls in the aforementioned study were from inpatient units [ 15 ], which often represent ward issues regarding active patients. Previous studies have shown that inpatient on-call services receive higher pager volumes during evening hours [ 7 , 15 ]. Our study showed that ophthalmology pager volumes are significantly lower during evenings/overnight.…”

Towards better understanding of workplace factors contributing to hospitalist burden and burnout prior to COVID-19 pandemic

“…and professional demographics (e.g., length of time since degree, length of time in the current setting, etc.). The survey also captured provider ratings on 25 items broadly based on the National Academy of Medicine's system approach to provider burnout ( National Academy of Medicine; Committee on Systems Approaches to Improve Patient Care by Supporting Clinician Well-Being, 2019 ) and included various evidence-based S-T workplace factors (e.g., interruptions and disruptions (e.g., frequent pages or interruptions for non-emergent issues ( Witherspoon et al, 2019 )), work-life integration (e.g., lack of time to exercise, and or engage in enjoyable activities outside of work ( Olson et al, 2014 )), patient-related factors (e.g., difficult interactions with patients and their families ( An et al, 2013 )), organizational culture, technology (e.g., efficiency and usability of EHR and other technologies ( Melnick et al, 2020 )) and communications and relationships within and outside groups). Participants were asked to rate the extent to which they felt the specific workplace factor contributed to burnout, with higher values representing stronger agreement that the factor did contribute to burnout (1 = strongly disagree and 7 = strongly agree).…”

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

“…This leads to increased stress, burnout rates, and frustrations during rounding periods among medical trainees. 3 An algorithm-based text page system for nursing staff would improve communication and rounding efficiency by utilizing a decision tree model. This tree would include the initial decision of page appropriateness during rounding times.…”