Resident Workload, Pager Communications, and Quality of Care

Patel, Shruti; Lynch, Raymond; Lee, J.S.; Ranney, David N.; Al-Holou, Shaza N.; Frost, Charles; Harris, M.; Lewin, Sarah A.; Liu, E.; Madenci, Arin L.; Majkrzak, Allen A.; Nelson, Jessica; Peterson, Sarah F.; Serecky, Kerri A.; Wilkinson, David; Wojcik, Brandon M.; Englesbe, Michael J.

doi:10.1016/j.jss.2009.11.217

Cited by 8 publications

(11 citation statements)

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“…Our study found a higher total number of interruptions compared to previous studies on interruptions on general medical wards [7,20,23,24], but a lower number of interruptions compared to interruptions on surgical wards and teams [25,26]. For example, in a study of operating room distractions, Antoniadis et al found that surgeons experienced interruptions 9.82 times per hour [27].…”

Section: Discussioncontrasting

confidence: 47%

Untitled

2017

Appl Clin Inform

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Introduction:Hospital-based medical services are increasingly utilizing team-based pagers and smartphones to streamline communications. However, an unintended consequence may be higher volumes of interruptions potentially leading to medical error. There is likely a level at which interruptions are excessive and cause a 'crisis mode' climate. Methods: We retrospectively collected phone, text messaging, and email interruptions directed to hospital-assigned smartphones on eight General Internal Medicine (GIM) teams at two tertiary care centres in Toronto, Ontario from April 2013 to September 2014. We also calculated the number of times these interruptions exceeded a pre-specified threshold per hour, termed 'crisis mode', defined as at least five interruptions in 30 minutes. We analyzed the correlation between interruptions and date, site, and patient volumes. Results: A total of 187,049 interruptions were collected over an 18-month period. Daily weekday interruptions rose sharply in the morning, peaking between 11 AM to 12 PM and measuring 4.8 and 3.7 mean interruptions/hour at each site, respectively. Mean daily interruptions per team totaled 46.2 ± 3.6 at Site 1 and 39.2 ± 4.2 at Site 2. The 'crisis mode' threshold was exceeded, on average, 2.3 times/day per GIM team during weekdays. In a multivariable linear regression analysis, site (β6.43 CI95% 5.44 -7.42, p<0.001), day of the week (with Friday having the most interruptions) (β0.481 CI95% 0.236 -0.730, p<0.05) and patient census (β1.55 CI95% 1.42 -1.67, p<0.05) were all predictive of daily interruption volume although there was a significant interaction effect between site and patient census (β-0.941 CI95% -1.18 --0.703, p<0.05). Conclusion: Interruptions were related to site-specific features, including volume, suggesting that future interventions should target the culture of individual hospitals. Excessive interruptions may have implications for patient safety especially when exceeding a maximal threshold over short periods of time.

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Section: Discussioncontrasting

confidence: 47%

Untitled

2017

Appl Clin Inform

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“…The volume of pages and their frequently nonurgent status may represent potential distractions for junior residents that may compromise the quality and safety of care, as has been suggested by other studies. 4 Previous studies have revealed a high degree of satisfaction among physicians with alpha-numeric paging systems, which can minimize interruptions in patient care 5,6 ; however, a recent study questioned the utility of this approach, citing a high incidence of poor or inadequate communications. 7 Two-way paging is another alternative and was preferred over one-way alpha-numeric pagers in one small study.…”

Section: Discussionmentioning

confidence: 99%

“…Paging practices and their burden on on-call residents have been studied in a variety of settings. [1][2][3][4][5][6][7][8][9] To date, only one study, conducted 2 decades ago, prospectively collected page priorities and the activities performed by the resident at the time pages were received. 2 Few studies have evaluated paging practices in surgical specialties, and none have prospectively evaluated paging priorities and the interruption of resident activities since the onset of the current duty hour limits.…”

Section: Introductionmentioning

confidence: 99%

An Observational Study of Hospital Paging Practices and Workflow Interruption Among On-Call Junior Neurological Surgery Residents

Fargen¹,

O’Connor²,

Raymond³

et al. 2012

Journal of Graduate Medical Education

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“…Yet, hospitals' communication systems still receive much less attention than information systems such as electronic health records. There is now growing literature on the limitations of traditional hospital communication systems such as alpha-numeric pagers, landlines, email, and unit intercoms [8][9][10][11][12]. Health care providers navigate an increasingly fragmented communication space that forces them to communicate through several disparate modes: face-face interactions, phone calls, oneways texts, pagers, or email.…”

Section: Introductionmentioning

confidence: 99%