Ever feel like throwing your pager against a wall and/or stomping on it? Me too. One of the very challenging aspects of modern medicine, not just during residency but worse during that time, is the fact that we’re interrupted so often. We can hardly write a note or orders, or have a conversation with another doctor or nurse, or consult in the ED, or counsel a patient without being interrupted.
This has many bad consequences: Orders may contain errors. Information may be omitted during handoffs. Historical or physical findings may be missed during a clinical evaluation. Patient confidence may suffer when they observe the physician continually looking at his pager and trying to hurry the encounter along.
In this month’s Journal of Graduate Medical Education, Fargen, et al. have published some data on this problem. The lead author is a neurosurgical resident at the University of Florida. He and 6 other residents participated in a study where 2 medical students on roration with them followed them around on call and recorded every page received between 7pm and 7am on 8 Friday and Saturday nights. They found:
- 55 pages per 12 hour shift
- 4.6 per hour
- One page every 13 minutes
- Paging frequency remained similar during prime sleeping hours of 2-5am
- Two thirds of the pages were non-urgent
I think we can all relate to this, and there are nursing data showing the same thing.
So what to do about it? Our hospitalist group has piloted one approach, which is to use a standard form of paging communication. Each page is to start with “Call:” “Come:” or “FYI:” If the person sending the page expects a call back, he/she is supposed to stay by the phone.
I think that’s a start, but it doesn’t change the fact that your pager has gone off and you have to stop what you’re doing and look at it to see how urgent it is. A complementary idea is to reserve paging for urgent matters only. All non-urgent matters go to the electronic medical record. While on call, residents and hospitalists probably sign in and out of the EMR several times per hour. Non-urgent matters could appear in the inbox, and there could be set an expectation that physicians check the inbox regularly.
The same could apply to patient phone calls. These could be taken by a dedicated pool of triage nurses. Emergent matters could result in the patient being told to activate EMS. Urgent ones would result in a page to the on-call physician. Less urgent matters, such as prescription refills, would go to the EMR to be addressed when the physician has a minute and would not be allowed to interrupt order-writing, an interview, or a procedure.
The big picture here is that as medical care becomes more fast-paced and complex, our communication tools need to adapt accordingly. Wearing a pager and getting beeped every time a patient’s potassium is found to be 3.2 just isn’t appropriate.