Transcript Can the Use of “One-Way”

Can the Use of One-Way
Communication Using Alphanumeric
Paging Lead to Problems in Patient
Care and Communication?
Sasa Espino BA, Diane Cox MD,
Brian Kaplan MD
Department of Surgery
Medical College of Virginia Hospitals,
Virginia Commonwealth University, Richmond VA
APDS MARCH 24, 2011
Disclosures
 NONE
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Background
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Paging - mainstay of communication in most
medical centers
Residents are often paged while
geographically separated from their patients
Pages have the potential to be disruptive to
residents’ daily activities, including work
rounds, conferences, and sleep
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Background - Evolution of
Communication
 Verbal
communication
– Direct person-to-person contact
 Paging
– Numeric
– Voice/tone
– Alphanumeric
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What we have now
One-way alphanumeric paging system
– Simple personal telecommunications device
– Telepage operators vs internet-based
 Benefits
– Increased physician and nurse satisfaction
– Decreased disruption to pt care, educational activities
– Decreased frequent paging of residents
– Improved physician and nursing workflow

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Implementation and Evaluation of an
Alphanumeric Paging System on a Resident
Inpatient Teaching Service
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Aim: Implement an alphanumeric paging system
on the General Internal Medicine inpatient wards
Measured proportion pages sent as text, source of
pages, content of pages, pages that disrupted
educational activities, satisfaction w paging system
Intervention included equipping residents w
alphanumeric pagers and increasing use of
internet-based system to send text pages
Wong et al. J Hosp Med 2009 4(8):E34.
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Results, Wong et al.
Pages that Disrupted Scheduled Educational Rounds
140
120
100
80
60
40
20
0
Total # pages
received during
rounds
Pages requiring
immediate call
back
Nov-05
Numeric pages*
Nov-06
*Total pages sent from Medicine ward or other physician
Text pages*
Jan-08
Wong et al. J Hosp Med 2009 4(8):E34.
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Alphanumeric Paging in an
Academic Hospital Setting
Aim: To see if alphanumeric pages improved
work environment in a large academic medical
center
 Pre and Postintervention surveys
 Intervention included implementation of
alphanumeric pages and detailed instruction
on the use of text pages by all users

Nguyen et al. Am J Surg 2005 191:561.
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Results, Nguyen et al.
Resident Paging Logs
Nurses: % answering "strongly agree" or "agree"
100
1000
900
800
700
600
500
400
300
200
100
0
90
80
70
60
50
40
30
20
10
0
Total # of pages
Interrupted pt care
Required a call back
Preintervention (%) Postintervention (%)
Saves time
Decreases frustration
Preintervention
Improves patient care
Postintervention
Nguyen et al. Am J Surg 2005 191:561.
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Why the Crisis?
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Potential for patient harm
– Missed pages
– Unclear text
Use as numeric paging
Potential HIPAA violations
Limited workstations
QuickTime™ and a
decompressor
are needed to see this picture.
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One-Way Communication at
VCU
 Aim:
Determine whether the use of
alphanumeric pagers may lead to
problems in patient care and/or
communication or provides any benefit
over numeric paging
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Method
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IRB approval obtained
Study setting: 779-bed academic medical center
Study population: residents on General Surgery,
Trauma Surgery, and Surgical ICU services
Pages collected over 3-month period
Resident name and pager numbers were blinded
52,384 total pages
– Pages categorized according to:
 Reason for page
 Type of follow-up required
 Potential HIPAA violations
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Results
Content of Page
Number (%)
Example
Callback number
11,884 (22.6)
x81234
Callback name and number 6,198 (11.8)
*Resident* x81234
Change in pt status
1273 (2.4)
Possible pneumothorax on CT pt s/p VATS
Test result
1037 (2.0)
US done on Pt X. Free fluid present, not there yesterday
Consult request
249 (0.48)
Pls call Team 1 regarding consult on Pt X w port-a-cath
swelling and erythema
Medication request
411 (0.78)
Pt X - can he have PO dose of Benadryl for sleep?
Trauma call
10,312 (19.7)
2222 Echo ETA 5 minutes
Team update
1803 (3.4)
8a rounds on Main Hosp 9. Have vitals ready
Paperwork request
127 (0.24)
When you have time, pls consent Pt X for toe amputation
Non pt-care related
124 (0.24)
Food in team room when you’re done w rounds
Other
19,354 (36.9)
*Includes error messages, unclear text pages, request for
call to outside number
Example: 804-555-1212 Home Health regarding Pt X
medication orders
Total
52,384 (100)
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Results
20,653 pages (39.4% of total) have potential to result in
patient harm

Content of
Page
Number
(%)
Example
Callback number
11,884 (22.6)
x81234
Callback name and
number
6,198 (11.8)
*Resident* x81234
Change in pt status
1273 (2.4)
Possible pneumothorax on CT pt s/p VATS
Test result
1037 (2.0)
US done on Pt X. Free fluid present, not
there yesterday
Consult request
249 (0.48)
Pls cal Team 1 regarding consult on Pt X w
port-a-cath swelling and erythema
Medication request
411 (0.78)
Pt X - can he have PO dose of Benadryl for
sleep?
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Results
 Use
as numeric paging
Content of Page
23%
Callback number
12%
65%
Callback number
and name
Information
Transfer
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Results
 Potential
HIPAA violations
– 2636 (5.0% of the total pages)
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Improving Communication
 Education
 Reply
message templates
 Smartphones for residents
 Elements for optimal implementation of
alphanumeric paging*
– Web-based paging system
– Two-way communication
– Safe, secure paging server
*Wong et al. J Hosp Med 2009 4:E34
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Next Steps
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Future research:
– Potential objective impact of
two-way communication on
patient safety and reducing
medical errors
QuickTime™ and a
decompressor
are needed to see this picture.
– Most effective way to educate
physicians and nurses
regarding appropriate use of
text paging
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Conclusion
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Effective communication is essential to safe and optimal
patient care
One-way alphanumeric paging can lead to errors in
communication, disruptions to patient care and physician
workflow
Biggest concern: inability of sender to immediately know if
recipient has received the page
Potential for incomplete or no transfer of important patient
care information, possibly resulting in patient harm
We have identified opportunities for improvement in
education and call attention to the potential benefits of
using two-way communication
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Limitations
 Limited
to study of pages sent residents
on 3 surgical services
 Limited time span of 3 months
 Retrospective study
– No paging logs collected
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Questions?
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