An Observational Study of Hospital Paging Practices and Workflow Interruption Among On-Call Junior Neurological Surgery Residents

Abstract

Previous studies suggest that nonurgent pages comprise a substantial portion of the pages received by residents while on duty. We evaluated the number, type, and urgency of pages received and the task being performed at the time of paging by on-call junior neurosurgery residents at a large teaching hospital, with the aim of providing insight into mechanisms that can be developed to improve paging patterns and ultimately reduce physician distractions due to nonurgent communications. For eight 12-hour call sessions, a medical student shadowed the on-call junior neurosurgery resident and recorded all pages received and the time, paging number and location, priority of the page (nonurgent, urgent, or emergency), and the activity the resident performed when the page was received. During one 5-hour session, a recorder measured the amount of time spent returning pages. During the study period, 439 communications were recorded (mean of 54.9 per 12-hour session; range, 33-75). Communications occurred at a rate of every 13minutes and ranged from every 34minutes to every 8.7minutes. Paging remained frequent even during the hours when on-call residents are most likely to sleep (2-5 am), with an average of 4 communications per hour. The time to return pages ranged from 15 to 174seconds (mean, 79.7seconds). Most pages were nonurgent (68.3%) and occurred during patient care activities (65%). Paging communications were frequent. Most pages were nonurgent and were received during important patient care activities. This suggests that a viable solution must address the work context of the individual being paged and the individual initiating the page to ensure that urgent communications are properly prioritized and attended to.