Resident Workload, Pager Communications, and Quality of Care

Abstract

With the recent regulations limiting resident work hours, it has become more important to understand how residents spend their time. The volume and content of the pages they receive provide a valuable source of information that give insight into their workload and help identify inefficiencies in hospital communication. We hypothesized that above a certain workload threshold, paging data would suggest breakdowns in communication and implications for quality of care. All pages sent to six general surgery interns at the University of Michigan over the course of one academic year (7/1/2008-6/30/2009) were retrospectively categorized by sender type, message type, message modifier, and message quality. Census, discharge, and admission information for each intern service were also collected, and intern duties were further analyzed with respect to schedule. "On-call" days were defined as days on which the intern bore responsibility for care of all admitted floor patients. The interns received a total of 9,843 pages during the study period. During on-call shifts, each intern was paged an average of 57 ± 3 times, and those on non-call shifts received an average of 12 ± 3 pages. Floor/intensive care unit (ICU) nurses represented 32% of the page volume received by interns. Interestingly, as patient volume increased, there was a decrease in the number of pages received per patient. By contrast, at higher patient volumes, there was a trend toward an increasing percentage of urgent pages per patient. At high intern workloads, our data suggest no major communication breakdowns but reveal the potential for inferior quality of care.

The use of technology for urgent clinician to clinician communications: A systematic review of the literature

“…15610–12 Patel et al studied pager messages sent to surgical interns at the University of Michigan Health System. 1 Paging data was reported over 18 months and were coded by two investigators who individually assigned sender type, message type, message modifier, and page quality. A total of 9,843 messages were received by the six interns.…”

“…Over the past 20 years, clinicians have faced an increasing communication burden, due in part to the proliferation of devices such as pagers, smart phones, and tablets. 1–3 Until the last several years, one-way numeric paging has been the main route of communication among clinicians and other multidisciplinary teams. The introduction of alphanumeric paging has allowed one-way communication to take place without the recipient having to respond via telephone call to each numeric page.…”

Mobile revolution: a requiem for bleeps?

“…The traditional method of using pagers as a means of communication is far from ideal; 65% interrupt patient care,1 a quarter are unimportant or unnecessary and only one-third actually result in a change to care 1 2. Junior doctors receive on average 60 bleeps per on-call shift, with peaks during nursing handover, increased volumes with reduced nursing workload, and only 16 min between bleeps at peak times 3. To address these problems junior doctors often resort to personal mobile phones, which are carried by 98%, and are used by 67% for work-related matters at an average cost of £14/month for hospital-related calls 4.…”

The role of technology in clinician-to-clinician communication

“…Research about the impact of trainee work-hour restrictions has exposed the communications burden experienced by resident physicians, much of which may be non-essential 6 7. A study of pager communications revealed that general surgery residents received an average of 57 (±3) pager communications or ‘pages’ during an ‘on-call’ shift, and that the proportion of urgent messages increased as resident workload increased 6.…”

“…A study of pager communications revealed that general surgery residents received an average of 57 (±3) pager communications or ‘pages’ during an ‘on-call’ shift, and that the proportion of urgent messages increased as resident workload increased 6. Nearly half the surgeries involving resident physicians are interrupted at least twice, and the overwhelming majority of the interruptions were later determined to be non-urgent 7.…”