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  • An Observational Study of Hospital Paging Practices and Workflow Interruption Among On-call Junior Neurosurgery Residents

    Final Number:

    Kyle Michael Fargen MD, MPH; Tim O'Connor BS; Steven Raymond; Justin M. Sporrer MD; William A. Friedman MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2012 Annual Meeting

    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.

    References: 1. Harvey R, Jarrett PG, Peltekian KM. Patterns of paging medical interns during night calls at two teaching hospitals. CMAJ 1994;151:307-11. 2. Blum NJ, Lieu TA. Interrupted care. The effects of paging on pediatric resident activities. Am J Dis Child 1992;146:806-8. 3. Katz MH, Schroeder SA. The sounds of the hospital. Paging patterns in three teaching hospitals. N Engl J Med 1988;319:1585-9. 4. Patel SP, Lee JS, Ranney DN, et al. Resident workload, pager communications, and quality of care. World J Surg;34:2524-9. 5. Nguyen TC, Battat A, Longhurst C, Peng PD, Curet MJ. Alphanumeric paging in an academic hospital setting. Am J Surg 2006;191:561-5. 6. Guerrero AF, Nunez LB, Thompson JC, Sharkey CD, Troncoso JA, Moon JL. Alphanumeric paging in an academic military hospital setting. Mil Med 2009;174:82-5. 7. Espino S, Cox D, Kaplan B. Alphanumeric paging: a potential source of problems in patient care and communication. J Surg Educ 2011;68:447-51. 8. Ighani F, Kapoor KG, Gibran SK, et al. A comparison of two-way text versus conventional paging systems in an academic ophthalmology department. J Med Syst 2010;34:677-84. 9. Wong BM, Quan S, Shadowitz S, Etchells E. Implementation and evaluation of an alpha-numeric paging system on a resident inpatient teaching service. J Hosp Med 2009;4:E34-40.

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