Introduction: Previous studies have suggested that non-urgent pages comprise a substantial portion of the pages received by resident physicians while on duty. Evaluating nurse-physician communication paging practices may be an important step in developing solutions that may enhance patient care and reduce unnecessary distractions that could lead to medical errors during busy call nights.
Methods: For eight 12-hour call sessions, a medical student shadowed the on-call junior neurosurgery resident at our institution and recorded all pages received as well as the time, paging number and location, priority of the page (non-urgent, urgent, or emergent), and the activity that was being performed when the page was received.
Results: Over the eight 12-hour shifts, 439 communications were recorded (range 33-75, mean 54.9). Communications occurred at a rate of 4.6 per hour (every 13 minutes), and ranged from as low as 1.75 per hour from 5-6 am (every 34 minutes) to as high as 6.9 per hour from 7-8pm (every 8.7 minutes). Paging remained frequent even during the hours when on-call residents are most likely to sleep (2 am to 5 am), with an average of 4 communications per hour (every 15 minutes). The time to return pages ranged from 15 to 174 seconds (mean 79.7 seconds). Most pages were non-urgent (68.3%) and occurred during patient care activities (65%). Residents spent a calculated 1.1 hours on the phone returning pages during each 12 hour shift.
Conclusions: The majority of pages were non-urgent and most were received during important patient care activities. Pages remained frequent (every 15 minutes) during the period of time when residents are most likely to sleep. Improvements in paging practices, particularly during early morning hours when residents are most likely to be fatigued and distracted, may be a means of reducing resident medical errors from distraction during patient care activities.
Patient Care: This research is specifically aimed at improving patient care at teaching hospitals by evaluating relevant issues regarding current paging practices involving on-call neurosurgical residents. By studying the nuances of nurse-physician communication at our hospital and describing the number and priority of pages and activities performed while pages are occurring, we can begin to offer solutions that may reduce unnecessary patient care distractions (from non-urgent pages) and enhance communication between health care workers that may optimize patient care and reduce medical errors. This research identifies important commmunication issues and offers solutions to obtain this goal.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Identify relevant issues regarding nurse-physician communication at large teaching hospitals, 2) Describe the number and priority of pages received at our institution by on-call residents and their effect on patiet care activities; 3) Identify potential solutions for optimizing nurse-resident physician communication.
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