Paging Systems Research Articles

Perceived Pager Burden Among Trainees Across Medical Specialties.

The experiences of pager use among trainees across medical specialties is underexplored. The aim of this study was to assess experiences of pager burden and communication preferences among trainees in different specialties. An online survey was developed to assess perceived pager burden (eg, pager volume, mistake pages, sleep, and off-time interruptions) and communication preferences at a tertiary center in the United States. All residents and fellows were eligible to participate. Responses were grouped by specialty: General surgery [GS], Surgical subspecialty [SS], Medicine, Anesthesiology, and Psychiatry. Multivariable linear regression was used to assess factors associated with pager burden. Free text responses were analyzed using open coding methods. Of the total 306 responses, the majority were female (58.8%), 30-39years (59.2%), and White (70.6%). Specialty breakdown was: Medicine (40.2%), Psychiatry (10.8%), SS (18.0%), GS (5.6%), and Anesthesiology (3.6%). GS respondents reported receiving more mistake pages (P < .001), spending more time redirecting mistake pages (P = .003), and having the highest sleep time disruptions (P < .001). For urgent communications, surgical trainees preferred physical pagers, while nonsurgical trainees preferred smartphone pagers (P = .001). "Receive fewer nonurgent pages" was the most common change respondents desired. In this single center study, subjective experiences of pager burden were disproportionately high among GS trainees. Reducing nonurgent and mistake pages are potential targets for improving trainee communication experiences. Hospitals should consider incorporating trainee preferences into paging systems. Additional studies are warranted to increase the sample size, assess generalizability of the findings, and contextualize trainee experiences with objective hospital-level paging data.

Trends in secure mobile communication technology use among hospitalists in North America, 2016–2021

ObjectivesStructured communication is essential for hospital-based clinicians to effectively coordinate patient care. However, traditional one-way paging systems are an inefficient means of information transfer. In response to the limitations of paging systems, vendors have developed secure text messaging systems (STMS) that provide asynchronous, multi-way messaging between mobile devices. In 2016 we conducted a cross-sectional survey of a nationally representative cohort of hospitalists and showed that pagers were used more frequently than STMS for patient care-related communication. Despite the potential benefits of STMS, we know little about the degree of STMS adoption since that time. The objective of this study was to quantify how STMS use has changed over time. MethodsWe re-administered our secure communication survey to the original cohort of hospitalists who responded to our initial survey, with a response rate of 25.4%. We used paired hypothesis tests to assess how hospitalist use and organizational adoption of STMS have changed since 2016. ResultsIn 2021, more respondents received messages primarily via STMS than they did in 2016 (n = 36 vs n = 14, difference in proportions 0.23, 95% CI 0.13–0.34, P<.001). Conversely, fewer respondents received messages via pager in 2021 than they did in 2016 (n = 21 vs n = 47, difference in proportions -0.27, 95% CI -0.38 to -0.17, P<.001). ConclusionsWe found that STMS has overtaken paging as the most frequently used technology for patient care-related communication. In addition, many hospitalists use both STMS and paging systems, placing them at risk for communication overload. Public Interest SummaryDoctors working in hospitals still use pagers to communicate. However, paging (receiving a message on a pager and having to call someone back) is slow and can lead to errors. New text messaging apps have been developed to let doctors send secure texts on their smartphones, but when we surveyed hospital-based internal medicine doctors (“hospitalists”) back in 2016, there was very little use of this technology. Because there seem to be benefits to using secure texting over paging, we wanted to show how trends in use of secure paging are changing over time. Here, we repeated our initial survey on the same group of hospitalists. We show that secure texting is now more common than paging, but many hospitalists have access to both. We caution that having too many communication options could lead to communication overload, and we suggest that best practices to prevent this should be studied.

Randomized Online Computation with High Probability Guarantees

We study the relationship between the competitive ratio and the tail distribution of randomized online problems. To this end, we identify a broad class of online problems for which the existence of a randomized online algorithm with constant expected competitive ratio r implies the existence of a randomized online algorithm that has a competitive ratio of (1+varepsilon )rwith high probability, measured with respect to the optimal profit or cost, respectively. The class of problems includes some of the well-studied online problems such as paging, k-server, and metrical task systems on finite metric spaces.

Wireless Paging System for Underground Mines

Underground working in different horizons with intricate haulage and traveling roadways is very complex in nature. Wired communication is presently the most adopted technology in Indian underground mines. Also, the cellular network cannot be used for communication due to the non-availability of the coverage link. So, addressing of key-personnel to pass on the information and assign task becomes a challenge for mine management. Implementation of wireless paging systems with routers and/or repeaters at strategic locations can instruct manpower for the jobs as well as obviate the impending mishap, if any, at remote locations of the mine. This paper presents a design of a wireless paging system for underground mines which consists of a two-way alphanumeric paging system operating on a ZigBee based wireless network and a paging terminal software. This paging system can be used to unicast or broadcast messages to all the pagers working in the RF network. A successful field trial of the same is also conducted to devise a node placement strategy for the routing units with prototype pagers in the shaft and traveling roadways at 400 and 500 m horizon of a deep underground coal mine.

Distractions During Patient Handoff: The Application-Based Messaging Volume on General Surgery Interns

Mobile phone-based paging systems have become increasingly common for communication within hospitals. Surgical interns receive the most pages, and our aim is to objectively quantify and evaluate this burden to allow for targeted improvement. We performed a retrospective review of our institutions mobile phone-based paging system data (Halo Health, Cincinnati, OH) from July 2019 to September 2019. Carolinas Medical Center, Charlotte, NC, USA. Seven general surgery postgraduate year (PGY) 1 residents. Forty-five thousand eight hundred and one messages met inclusion criteria, with 27,397 messages received and 18,404 sent. PGY 1 residents each received an average of 48 ± 41 messages per shift, with 8 ± 17 messages per day while off-duty. Night shifts averaged more messages than day shifts (80 ± 39 vs 38 ± 32, p < 0.0001), and had more shifts with high message volume (30% vs 11%, p = 0.0005). Evaluating the total number of messages received per minute of the day, the largest number of high-volume message intervals (21) occurred during patient handoff (1700-1900 hours). Most messages were sent by nursing staff (55.8%), followed by medical providers (38.2%). PGY 1 residents receive a large number of pages using a messaging application, with many occurring at critical times. Residents received a higher volume of pages on night shifts, during patient handoff, and while off-duty. Since most pages are from nursing staff, targeted education and preventative actions may help decrease the volume of pages during these critical times.

Hierarchical Orchestration of Disaggregated Memory

This article presents XMemPod , a hierarchical disaggregated memory orchestration system. XMemPod virtualizes cluster wide memory to scale large memory workloads in virtualized clouds. It makes three novel contributions: (1) XMemPod offers efficient, transparent, and dynamic sharing of available memory that is disaggregated across VMs on the same host or in the cluster. (2) XMemPod provides a hierarchical memory expansion framework, which enables memory-intensive workloads on a VM to expand its memory demand over virtualized host memory first, and remote memory next, before resorting to external disk. (3) XMemPod provides a suite of optimization techniques to further improve the utilization and access latency of disaggregated memory. XMemPod is deployed on a virtualized RDMA cluster without any modifications to user applications and the OSes. Evaluated with multiple workloads on unmodified Spark, Apache Hadoop, Memcached, Redis and VoltDB, using XMemPod , throughputs of these applications improve by 11x to 612x over conventional Linux, and by 1.7x to 14x over the existing representative remote memory paging systems, and yet the total amount of network traffic consumed by XMemPod is only 24 percent of the existing approaches.

Is it time to rethink how we page physicians? Understanding paging patterns in a tertiary care hospital

BackgroundFrequent pages can disrupt workflow, interrupt patient care, and may contribute to physician burnout. We hypothesized that paging volumes followed consistent temporal trends, regardless of the medical or surgical service, reflecting systems based issues present in our hospitals.MethodsA retrospective review of the hospital paging systems for 4 services at The Ottawa Hospital was performed. Resident paging data from April 1 to July 31, 2018 were collected for services with a single primary pager number including orthopaedic surgery, general surgery, neurology, and neurosurgery. Trends in paging volume during the 4-month period were examined. Variables examined included the location of origin of the page (emergency room vs. inpatient unit), and day/time of the page.ResultsDuring the study period, 25,797 pages were received by the 4 services, averaging 211 (± Standard Deviation (SD) 12) pages per day. 19,371 (75%) pages were from in-patient hospital units, while 6426 (24%) were pages from the emergency room. The median interval between pages across all specialties was 22:30 min. Emergency room pages peaked between 16:30 and 20:00, while in-patient units peaked between 17:30 and 18:30.ConclusionsEach service experienced frequent paging with similar patterns of marked increases at specific times. This study identifies areas for future study about what the factors are that contribute to the paging patterns observed.

Electronic health records, communication, and data sharing: challenges and opportunities for improving the diagnostic process.

Background Diagnosis requires that clinicians communicate and share patient information in an efficient manner. Advances in electronic health records (EHRs) and health information technologies have created both challenges and opportunities for such communication. Methods We conducted a multi-method, focused ethnographic study of physicians on general medicine inpatient units in two teaching hospitals. Physician teams were observed during and after morning rounds to understand workflow, data sharing and communication during diagnosis. To validate findings, interviews and focus groups were conducted with physicians. Field notes and interview/focus group transcripts were reviewed and themes identified using content analysis. Results Existing communication technologies and EHR-based data sharing processes were perceived as barriers to diagnosis. In particular, reliance on paging systems and lack of face-to-face communication among clinicians created obstacles to sustained thinking and discussion of diagnostic decision-making. Further, the EHR created data overload and data fragmentation, making integration for diagnosis difficult. To improve diagnosis, physicians recommended replacing pagers with two-way communication devices, restructuring the EHR to facilitate access to key information and improving training on EHR systems. Conclusions As advances in health information technology evolve, challenges in the way clinicians share information during the diagnostic process will rise. To improve diagnosis, changes to both the technology and the way in which we use it may be necessary.

Dangers of Distractions [Electrical Safety

Examines the impact distractions have on industrial electrical safety. Workers and their supervisors are constantly interrupted during their work. If you spend any time at an industrial facility, you know that paging systems and calls on mobile devices are in constant use and make it hard to concentrate. At sites with limited resources, the electrical workers may have other extended responsibilities beyond the job at hand.

Quality of Communication: Paging System Use in the Smartphone Era

Background: Paging-systems (PS) are important means of communication between providers. PS may provide only limited information, and quality of communication (QOC) may be suboptimal. To investigate QOC using PS at a general surgery residency program. Methods: 7 surgical services pagers records were obtained from communication department over 24 hour in 2017. In addition to frequency, pages were evaluated for 5-quality metrics: paging party, callback number, urgency, reason for page, and patient identifiers. A survey was distributed to general surgery residents evaluating their perception of QOC. Results: 126 pages were captured over 24 hours (61% am-shift, 39% pm-shift). Thirty-two% contained only a callback number, and 20% contained all 5-components. Fifty-one% were from patient wards, 28% consultants, and 21% peri-operative services. 97% did not include urgency, and 39% reason for page. Median components was 3, with consultants having an OR=6; [CI95%:1.9-18.2] (p 1 min on-hold. Majority agreed that callback only may lead to loss of time and felt that standardizing paging can improve communication. Conclusion: The PS is still relevant in a hospital setting. Many pages could be improved to facilitate efficient communication to surgery residents. Residents feel strongly that there is room to improve QOC between providers. Despite relevance of PS, updating the system is necessary to improve inter-professional communication.

Exploring the Relevance of Search Engines: An Overview of Google as a Case Study

The huge amount of data on the Internet and the diverse list of strategies used to try to link this information with relevant searches through Linked Data have generated a revolution in data treatment and its representation. Nevertheless, the conventional search engines like Google are kept as strategies with good reception to do search processes. The following article presents a study of the development and evolution of search engines, more specifically, to analyze the relevance of findings based on the number of results displayed in paging systems with Google as a case study. Finally, it is intended to contribute to indexing criteria in search results, based on an approach to Semantic Web as a stage in the evolution of the Web.

Interprofessional Communication of Clinicians Using a Mobile Phone App: A Randomized Crossover Trial Using Simulated Patients.

BackgroundMost hospitals use paging systems as the principal communication system, despite general dissatisfaction by end users. To this end, we developed an app-based communication system (called Hark) to facilitate and improve the quality of interpersonal communication.ObjectiveThe objectives of our study were (1) to assess the quality of information transfer using pager- and app-based (Hark) communication systems, (2) to determine whether using mobile phone apps for escalation of care results in additional delays in communication, and (3) to determine how end users perceive mobile phone apps as an alternative to pagers.MethodsWe recruited junior (postgraduate year 1 and 2) doctors and nurses from a range of specialties and randomly assigned them to 2 groups who used either a pager device or the mobile phone-based Hark app. We asked nurses to hand off simulated patients while doctors were asked to receive handoff information using these devices. The quality of information transfer, time taken to respond to messages, and users’ satisfaction with each device was recorded. Each participant used both devices with a 2-week washout period in between uses.ResultsWe recruited 22 participants (13 nurses, 9 doctors). The quality of the referrals made by nurses was significantly better when using Hark (Hark median 118, range 100–121 versus pager median 77, range 39–104; P=.001). Doctors responded to messages using Hark more quickly than when responding to pagers, although this difference was not statistically significant (Hark mean 86.6 seconds, SD 96.2 versus pager mean 136.5 seconds, SD 201.0; P=.12). Users rated Hark as significantly better on 11 of the 18 criteria of an information transfer device (P<.05) These included “enhances interprofessional efficiency,” “results in less disturbance,” “performed desired functions reliably,” and “allows me to clearly transfer information.”ConclusionsHark improved the quality of transfer of information about simulated patients and was rated by users as more effective and efficient, and less distracting than pagers. Using this device did not result in delay in patient care.

Utilization of Workflow Process Maps to Analyze Gaps in Critical Event Notification at a Large, Urban Hospital.

Stroke care is a time-sensitive workflow involving multiple specialties acting in unison, often relying on one-way paging systems to alert care providers. The goal of this study was to map and quantitatively evaluate such a system and address communication gaps with system improvements. A workflow process map of the stroke notification system at a large, urban hospital was created via observation and interviews with hospital staff. We recorded pager communication regarding 45 patients in the emergency department (ED), neuroradiology reading room (NRR), and a clinician residence (CR), categorizing transmissions as successful or unsuccessful (dropped or unintelligible). Data analysis and consultation with information technology staff and the vendor informed a quality intervention-replacing one paging antenna and adding another. Data from a 1-month post-intervention period was collected. Error rates before and after were compared using a chi-squared test. Seventy-five pages regarding 45 patients were recorded pre-intervention; 88 pages regarding 86 patients were recorded post-intervention. Initial transmission error rates in the ED, NRR, and CR were 40.0, 22.7, and 12.0%. Post-intervention, error rates were 5.1, 18.8, and 1.1%, a statistically significant improvement in the ED (p < 0.0001) and CR (p = 0.004) but not NRR (p = 0.208). This intervention resulted in measureable improvement in pager communication to the ED and CR. While results in the NRR were not significant, this intervention bolsters the utility of workflow process maps. The workflow process map effectively defined communication failure parameters, allowing for systematic testing and intervention to improve communication in essential clinical locations.

Incorporating smartphones into clinical practice.

Incorporating smartphones into clinical practice.

Smarter hospital communication: secure smartphone text messaging improves provider satisfaction and perception of efficacy, workflow.

BACKGROUNDThough current hospital paging systems are neither efficient (callbacks disrupt workflow), nor secure (pagers are not Health Insurance Portability and Accountability Act [HIPAA]-compliant), they are routinely used to communicate patient information. Smartphone-based text messaging is a potentially more convenient and efficient mobile alternative; however, commercial cellular networks are also not secure.OBJECTIVETo determine if augmenting one-way pagers with Medigram, a secure, HIPAA-compliant group messaging (HCGM) application for smartphones, could improve hospital team communication.DESIGNEight-week prospective, cluster-randomized, controlled trialSETTINGStanford HospitalINTERVENTIONThree inpatient medicine teams used the HCGM application in addition to paging, while two inpatient medicine teams used paging only for intra-team communication.MEASUREMENTSBaseline and post-study surveys were collected from 22 control and 41 HCGM team members.RESULTSWhen compared with paging, HCGM was rated significantly (P < 0.05) more effective in: (1) allowing users to communicate thoughts clearly (P = 0.010) and efficiently (P = 0.009) and (2) integrating into workflow during rounds (P = 0.018) and patient discharge (P = 0.012). Overall satisfaction with HCGM was significantly higher (P = 0.003). 85% of HCGM team respondents said they would recommend using an HCGM system on the wards.CONCLUSIONSSmartphone-based, HIPAA-compliant group messaging applications improve provider perception of in-hospital communication, while providing the information security that paging and commercial cellular networks do not. Journal of Hospital Medicine 2014;9:573–578. © 2014 The Authors Journal of Hospital Medicine published by Wiley Periodicals, Inc. on behalf of Society of Hospital Medicine

Operational Status of Operation Paging Systems During the Great East Japan Earthquake and Techinical Trends

Operational Status of Operation Paging Systems During the Great East Japan Earthquake and Techinical Trends

Communication Latencies of Apple Push Notification Messages Relevant for Delivery of Time-Critical Information to Anesthesia Providers

Tablet computers and smart phones have gained popularity in anesthesia departments for educational and patient care purposes. VigiVU(™) is an iOS application developed at Vanderbilt University for remote viewing of perioperative information, including text message notifications delivered via the Apple Push Notification (APN) service. In this study, we assessed the reliability of the APN service. Custom software was written to send a message every minute to iOS devices (iPad(®), iPod Touch(®), and iPhone(®)) via wireless local area network (WLAN) and cellular pathways 24 hours a day over a 4-month period. Transmission and receipt times were recorded and batched by days, with latencies calculated as their differences. The mean, SEM, and the exact 95% upper confidence limits for the percent of days with ≥1 prolonged (>100 seconds) latency were calculated. Acceptable performance was defined as mean latency <30 seconds and ≤0.5% of latencies >100 seconds. Testing conditions included fixed locations of devices in high signal strength locations. Mean latencies were <1 second for iPad and iPod devices (WLAN), and <4 seconds for iPhone (cellular). Among >173,000 iPad and iPod latencies, none were >100 seconds. For iPhone latencies, 0.03% ± 0.01% were >100 seconds. The 95% upper confidence limits of days with ≥1 prolonged latency were 42% (iPhone) and 5% to 8% (iPad, iPod). The APN service was reliable for all studied devices over WLAN and cellular pathways, and performance was better than third party paging systems using Internet connections previously investigated using the same criteria. However, since our study was a best-case assessment, testing is required at individual sites considering use of this technology for critical messaging. Furthermore, since the APN service may fail due to Internet or service provider disruptions, a backup paging system is recommended if the APN service were to be used for critical messaging.

Abstract 127: Novel Approach to the Management of Clinical Alarm Fatigue

Is the answer to clinical alarm fatigue to silence an increasing number of alarms as many centers have done to improve staff sensitivity to alarms or to layer additional technology such as viewing stations or alarm alert paging systems to capture clinician attention? An Alarm Management Pilot at Boston Medical Center shows a different strategy. BMC clinicians observed that RN staff frequently did not respond to Arrhythmia and HR violation Warning Alarms allowing these often to self reset. They were almost always continuously present in the background competing with other alarms even call lights. A QI initiative was proposed for a Pilot on a 24 bed general cardiology floor to remove Warning Alarms for Arrhythmia and HR Limit violations. We chose not to silence HR violations as had been done in other medical centers but to elevate these to Crisis Alarm slightly widening their defaults. We did this having seen bradycardia or tachycardia alarms precede life threatening events not caused by sudden death from VF. As a Crisis Alarm these alarms would now require RN staff to view and act on the alarm in real time either responding to the patient or modifying alarm limits . The Pilot was an overnight success the noise reduction immediately noticed by staff and as this occurred alarm culture changed. We saw a startling 87% decrease in the total number of audible alarms from 87823/ week Pre Pilot to 9967/ week Post Pilot on pilot unit with the average number of daily alarms dropping from 12546 to 1424. The decibel level too decreased from an average peak value in the mid 80s Pre Pilot to the mid 60s Post Pilot. RNs queried with a Monkey Survey tool when asked “ Do you believe that the Pilot has improved the noise level on the unit?", 100% of respondents said yes. Among their comments ~The monitors were an irritant. Now they no longer seem that way. ~I can spend more time on patient care instead of answering meaningless alarms. ~I feel so much less drained going home at the end of my shift. Patient Satisfaction scores Post Pilot showed significant improvement : noise level in and around room increasing by 7%, nurse domain increasing by 30%, promptness to call light increasing by 31% and overall assessment increasing by 59%. Since there had been no interventions targeted specifically at improving the scores it suggest that the improvement in scores had been effected by the alarm changes and perhaps clinical alarm fatigue played a role as a major patient dissatisfier as well. Boston Medical Center is among the hospitals nationally attempting to tackle clinical alarm fatigue. This Alarm Management Pilot now rolling out to the rest of BMC provides a strategy for managing clinical alarm fatigue without adding additional technology or costs and demonstrates such a strategy not only can improve patient safety but can have a measurable positive effect on staff and patient satisfaction .

Advanced Nurse-Patient Communication System

Effective communication is the most important part of any healthcare organization. For many years, hospital nurse call solutions had been stand-alone systems with occasional integration to pocket paging for outputting patient call alerts to mobile staff. In the late 1990's, technology enabled in-building wireless phones to supplement or replace paging systems as a means of not only sending alerts, but also enabling voice communication between mobile staff and patients. Today's nurse call market requires integration of additional information from location and ADT (admit, discharge, transfer) systems into what have traditionally been nurse call applications. This system information is required not only at the nursing station, pagers, and phones, but also at PC's placed on each patient care floor in hallways, nurse stations, and offices, and at areas away from the patients, including administrator and clinical engineering offices. It is crucial that nurses have the latest patient information in their hand wherever they go in the hospital. In this paper, MatchMaker.NET has been developed to integrate all these technologies into the hospital's LAN to improve nurse-patient communication.

Anesthesiology: From Patient Safety to Population Outcomes

Anesthesiology: From Patient Safety to Population Outcomes