Text Paging Research Articles

Completeness and quality of text paging for subspecialty consult requests

It is unclear whether previously developed frameworks for effective consultation apply to requests initiated by alphanumeric text page. We assessed a random sample of 210 text paged consult requests for...

Improving the voir dire process: A prospective juror's perspective

While the U.S. legal system takes pains to treat jury trial defendants fairly, it tends to treat prospective jurors unfairly, as if their time had little value. Citizens might view performing this important civic duty more favorably if the court made better use of their time. This article studies the voir dire phase of jury selection in California courts and investigates how it can be made more pleasant and productive from a prospective juror's perspective. A discrete-event computer simulation model of the process was built to test an alternative approach to handling jurors during voir dire, in which some are permitted to leave the courtroom and use their out-of-courtroom time as they wish, e.g., working or reading. Jurors can be recalled to the courtroom as needed via text messaging or paging, so the approach should be relatively easy to implement. Experiments performed with the model found that, depending on trial characteristics, jurors allowed to leave the courtroom would likely would recoup an average of one to 4 h, collectively recover dozens to hundreds of hours, comprising 15–30% of the total time spent by all jurors at the courthouse for voir dire, and potentially save several thousand dollars in lost income.

What's in a Name? Factors That Influence the Usage of Generic Versus Trade Names for Cardiac Medications Among Healthcare Providers.

What's in a Name? Factors That Influence the Usage of Generic Versus Trade Names for Cardiac Medications Among Healthcare Providers.

An Innovative Approach to Improve Communication and Reduce Physician Stress and Burnout in a University Affiliated Residency Program.

Ineffective communication between nursing staff and residents leads to numerous educational and patient-care interruptions, increasing resident stress and overall workload. We developed an innovative and simple, secure electronic health record (EHR) base text paging system to communicate with internal medicine residents. The goal is to avoid unnecessary interruption during patient care or educational activities and reduce stress. Traditional paging system can send a phone number to call back. We developed and implemented a HIPPA-compliant, EHR-integrated text paging at a busy 591-bed urban hospital. Access was granted to unit clerks, nursing staff, case managers, and physicians. Senders could either send a traditional telephone number page or a text page through our EHR. The recipient could then either acknowledge receipt of the page or take appropriate actions. Afterward, Internal medicine residents were polled on overall satisfaction difference between basic phone based numeric paging and the enhanced EHR text paging system. Educational interruptions (averaging over 7 pages) decreased from 64% to 16%. Patient care interruptions fell from 68% to 12%. 88% of residents felt that 50% or less of the pages were non-emergent and did not require an immediate action. 92% of 25 surveyed internal medicine residents preferred text paging over numeric paging and responded through the EHR 60% of the time by placing direct orders. Time savings using the new system over a 3-month span amounted to 72.5h in transmission time alone. Text paging among medical caregivers and internal medicine residents through EHR-associated communication reduced patient care and educational interruptions. It saved time spent sending pages, answering unnecessary pages and it improved resident's subjective stress and satisfaction levels.

Improving Communication Through Resident-Nurse Shadowing.

Previously, reduced resident hours, multiple ways to communicate (text paging, calling), and fewer opportunities for face-to-face communication had led to increased frustration from residents and nurses in our institution about communicating and prioritizing patient care needs. It was thought that a shared understanding and improved teamwork and communication between residents and nurses might be achieved if the residents could watch the nurses' workflow and observe their care priorities. To understand the experience of residents and nurses who had participated in a novel 4-hour nurse shadowing experience conducted during the first year of pediatric medical residency in a children's hospital. We undertook a basic interpretive qualitative study by using semistructured interviews to formally evaluate the shadowing program by examining the experiences of both the first-year residents and the nurses being shadowed. Residents and nurses who had participated in the past 3 years were eligible for inclusion in the study. Seven themes emerged that supported the overarching theme of improving communication between residents and nurses. Shadowing led to improved resident understanding and appreciation of nurses' work. Both residents and nurses experienced enhanced relationships as they discussed opportunities to improve care delivery. Residents reported practice changes after shadowing a nurse. Peer relationships formed among the dyads that extended beyond the shadowing experience. Shadowing a nurse proved to be a valuable experience that had an impact on participants and potentially a positive impact on patient care.

Let's Talk: Communication Errors in Radiation Oncology

Although communication is well-appreciated as a potential source of error, little is known about the specific nature and causes of communication errors particularly in the radiation oncology (RO) context. This study used an institutional incident learning system (ILS) to develop a RO-specific classification schema for communication errors with the goal of informing interventions to reduce errors in treatment. Departmental ILS events from January 2012 to January 2017 were analyzed and reports specific to communication were identified. Events were classified by communication type (written, verbal, other), and written incidents were further sub-classified (electronic medical record (EMR), email, text paging). The individuals responsible for sending and receiving the communication were identified. The nature of the communication failure was categorized as: miscommunication, communication absent (not sent), communication not received, or poor communication without incident. Events were classified by point of error origination and detection based on a previously established workflow. A total of 4,617 safety-related events were captured over the 5-year period with 1002 (22%) directly involving communication. Of these, 400 events were selected at random for analysis; 20% of these were potentially severe events. Individuals responsible for sending and detecting communication errors are shown in Table 1. Written communication errors comprise 62% of communication events, whereas verbal errors were 32%. Of the written errors, 87% involved the use of the EMR for communication. Absence of communication and a miscommunication were important factors in 50% and 21% of events respectively. Most communication events (54%) originated during patient assessment or treatment planning phases. To our knowledge this is the first study to examine and classify communication errors in RO. Communication is a common contributing factor to safety events, and our results show that written communication errors are most prevalent, most often driven by poor communication through the EMR. The RO physician was the most common source of error. This work lays a foundation for further efforts to improve communication and reduce errors in patient care and treatment.Abstract 3300; Table 1VariableN (%)Person sendingRO physician154 (39%)Therapist102 (26%)Dosimetrist43 (11%)Person receivingTherapist189 (47%)RO attending157 (39%)Dosimetrist65 (16%)Patient36 (9%) Open table in a new tab

Is Clinician Text Paging Safe for Patients

Since the introduction of alphanumeric pagers nearly 3 decades ago, text paging has permitted efficient communication streams between clinicians. To

Efficiency and Interpretability of Text Paging Communication for Medical Inpatients

This mixed-methods analysis investigates text page message content among clinicians regarding patient care with particular focus on efficiency and safety.

Comparison of methods of alert acknowledgement by critical care clinicians in the ICU setting.

BackgroundElectronic Health Record (EHR)-based sepsis alert systems have failed to demonstrate improvements in clinically meaningful endpoints. However, the effect of implementation barriers on the success of new sepsis alert systems is rarely explored.ObjectiveTo test the hypothesis time to severe sepsis alert acknowledgement by critical care clinicians in the ICU setting would be reduced using an EHR-based alert acknowledgement system compared to a text paging-based system.Study DesignIn one arm of this simulation study, real alerts for patients in the medical ICU were delivered to critical care clinicians through the EHR. In the other arm, simulated alerts were delivered through text paging. The primary outcome was time to alert acknowledgement. The secondary outcomes were a structured, mixed quantitative/qualitative survey and informal group interview.ResultsThe alert acknowledgement rate from the severe sepsis alert system was 3% (N = 148) and 51% (N = 156) from simulated severe sepsis alerts through traditional text paging. Time to alert acknowledgement from the severe sepsis alert system was median 274 min (N = 5) and median 2 min (N = 80) from text paging. The response rate from the EHR-based alert system was insufficient to compare primary measures. However, secondary measures revealed important barriers.ConclusionAlert fatigue, interruption, human error, and information overload are barriers to alert and simulation studies in the ICU setting.

Hospital text paging communication as a surgical quality improvement initiative

BackgroundStudies on medicine wards have shown that numeric pages can be disruptive of workflow and patient care. We created a quality improvement program among surgical ward nurses and residents and hypothesized that a text-based, urgency-stratified initiative would improve communication at no detriment to patient care. MethodsSurgery residents recorded preintervention data for 1 mo including number of total pages, text pages, and numeric pages received from surgical floors. Nurses and residents completed surveys to assess preintervention satisfaction with communication, responsiveness, and workflow. Nurses were then instructed to use text paging for nonurgent issues. Paging data were again recorded for 1 mo, surveys repeated, and patient safety and satisfaction data collected. Primary endpoints evaluated included patient safety and satisfaction data. Secondary endpoints included communication satisfaction of nurses and residents. ResultsAfter text paging implementation, 40.1% of nonurgent pages sent from nurses to resident physicians were alphanumeric texts versus only 17.9% before implementation (P < 0.0001). There was a 19.5% reduction in the number of nonurgent numeric pages sent (P < 0.0001). Overall, 70% of nurses responded postintervention that text paging was the preferred method of contacting a physician and that the text paging initiative improved efficiency. After implementation, 62% of nurses thought that overall communication with clinicians improved. In addition, there was no change in patient safety issues or patient satisfaction. ConclusionsOur text paging initiative for all nonurgent pages from nurses to residents improved physician–nurse workflow and communication on the surgical ward with no decrease in patient satisfaction or safety.

E-DIP: Early Discharge Project. A Model for Throughput and Early Discharge for 1-Day Admissions

Short stay admissions that are outside of observation unit models hold challenges for throughput and decreasing length of stay (LOS). In our institution at Mount Sinai Hospital in New York...

The Effect of Paging Reminders on Fellowship Conference Attendance: A Multi-Program Randomized Crossover Study

Educational conferences have long served as a foundation of medical education. Sending reminder text pages prior to the start of conferences is a method that may be employed to enhance conference attendance. The goal of our study was to determine if routine text paging before regularly scheduled conferences improves attendance among fellows in 3 internal medicine programs. A prospective, randomized, crossover study included 3 fellowship programs: pulmonary and critical care, cardiovascular disease, and hematology-oncology. The study was performed between October 2014 and March 2015. All fellows were included and randomized to 1 of 2 groups (with subsequent crossover to opposite group): Pages or No Pages. Paging reminders, which included conference title, location, and time, were sent 30 minutes prior to every conference for those in the intervention arm. Attendance was collected through a standard attendance log using self-registration. A total of 46 fellows and 156 conferences were included for analysis, with 75 during the first 3 months and 81 during the second 3 months. There were no differences in individual overall attendance between randomized groups for the entire study period (42.9% versus 46.5%, P = .46). Paging reminders had no effect on overall individual attendance (43.7% versus 45.6%, P = .50). In addition, no significant differences were identified for individuals within each fellowship and training year. Paging reminders prior to a regularly scheduled conference had no effect on overall attendance in this study. Fellows reported that clinical obligations were a major barrier to conference attendance.

Text paging of surgery residents: Efficacy, work intensity, and quality improvement

Text pages can communicate important information but also disrupt workflow, which can affect the safety of patient care. The purpose of this study was to analyze the content, volume, and distribution of text pages received by general surgery residents and physician's assistants (PAs) using natural language processing (NLP). We studied text pages received by residents and PAs at a tertiary care teaching hospital from March to May 2012 using NLP. The number and content of pages were stratified by recipient seniority, surgical service, patient census, and patient location. Chi-square tests, t test, and analysis of variance were used to detect statistical significance. We captured 48,202 pages. The average number (mean ± standard deviation) of pages per hour was 3.1 ± 2.2 for postgraduate year (PGY)-1s and 2.8 ± 1.9 for PAs (P < .0001). The greatest number of pages per day by Service was 86.1 ± 37.5 on the acute care surgery service. The most common paging topic was medications (18,444 [38.3%]) and the most common symptom was pain (6,240 pages [12.9%]). On services where patients were located near each other (regionalized), the number of pages per day per recipient per patient on census was almost half that compared with nonregionalized services (1.40 vs 2.43; P < .0001). Residents receive a high volume of pages at this tertiary care center, particularly regarding medications and pain. Services with regionalized patients exhibit less paging need per patient. Initiatives to improve pain management and regionalize patients may streamline communication, decrease the number of pages, and increase patient safety.

Natural Language Processing of Text Paging in the Surgical Work Setting

Natural Language Processing of Text Paging in the Surgical Work Setting

Interpretation of the Association Between Frequency of Self-Reported Medical Errors and Faculty Supervision of Anesthesiology Residents

Interpretation of the Association Between Frequency of Self-Reported Medical Errors and Faculty Supervision of Anesthesiology Residents

Role of Communication Systems in Coordinating Supervising Anesthesiologists’ Activities Outside of Operating Rooms

Theoretically, communication systems have the potential to increase the productivity of anesthesiologists supervising anesthesia providers. We evaluated the maximal potential of communication systems to increase the productivity of anesthesia care by enhancing anesthesiologists' coordination of care (activities) among operating rooms (ORs). At hospital A, data for 13,368 pages were obtained from files recorded in the internal alphanumeric text paging system. Pages from the postanesthesia care unit were processed through a numeric paging system and thus not included. At hospital B, in a different US state, 3 of the authors categorized each of 898 calls received using the internal wireless audio system (Vocera(®)). Lower and upper 95% confidence limits for percentages are the values reported. At least 45% of pages originated from outside the ORs (e.g., 20% from holding area) at hospital A and at least 56% of calls (e.g., 30% administrative) at hospital B. In contrast, requests from ORs for urgent presence of the anesthesiologist were at most 0.2% of pages at hospital A and 1.8% of calls at hospital B. Approximately half of messages to supervising anesthesiologists are for activity originating outside the ORs being supervised. To use communication tools to increase anesthesia productivity on the day of surgery, their use should include a focus on care coordination outside ORs (e.g., holding area) and among ORs (e.g., at the control desk).

Limiting ventilator-induced lung injury through individual electronic medical record surveillance*

To improve the safety of ventilator care and decrease the risk of ventilator-induced lung injury, we designed and tested an electronic algorithm that incorporates patient characteristics and ventilator settings, allowing near-real-time notification of bedside providers about potentially injurious ventilator settings. Electronic medical records of consecutive patients who received invasive ventilation were screened in three Mayo Clinic Rochester intensive care units. The computer system alerted bedside providers via the text paging notification about potentially injurious ventilator settings. Alert criteria included a Pao2/Fio2 ratio of <300 mm Hg, free text search for the words "edema" or "bilateral + infiltrates" on the chest radiograph report, a tidal volume of >8 mL/kg predicted body weight (based on patient gender and height), a plateau pressure of >30 cm H2O, and a peak airway pressure of >35 cm H2O. Respiratory therapists answered a brief online satisfaction survey. Ventilator-induced lung injury risk was compared before and after the introduction of ventilator-induced lung injury alert. The prevalence of acute lung injury was 42% (n = 490) among 1,159 patients receiving >24 hrs of invasive ventilation. The system sent 111 alerts for 80 patients, with a positive predictive value of 59%. The exposure to potentially injurious ventilation decreased after the intervention from 40.6 ± 74.6 hrs to 26.9 ± 77.3 hrs (p = .004). Electronic medical record surveillance of mechanically ventilated patients accurately detects potentially injurious ventilator settings and is able to influence bedside practice at moderate costs. Its implementation is associated with decreased patient exposure to potentially injurious mechanical ventilation settings.

HIV Prevention and Care in the Digital Age

To describe the technologic advances in the digital media, including computers, mobile phones, and the Internet, that have greatly expanded opportunities to deliver evidence-based HIV education, prevention, and treatment programs. This article examines the use of digital media in the United States and its potential role in HIV prevention and care. Although the "digital divide" is shrinking, access varies by age, race/ethnicity, and education. The Internet is an important medium for delivering universal and targeted HIV education and prevention, especially for men who have sex with men, who report going online to seek health information online and for social and sexual networking. Online and off-line behavioral interventions using digital media range from computerized multimedia interventions that take into account individual behaviors to brief untailored video interventions. Numerous Web sites facilitate access to care by providing a variety of services, including location of and linkage to HIV testing and treatment sites. HIV treatment and adherence programs that use online medical records text messaging, paging, and tablet computer-based counseling tools are also being developed. HIV prevention and care programs using digital media have great potential to cost-effectively meet the complex needs of diverse and often underserved populations living with or at high risk of HIV.

Implementation and evaluation of an alphanumeric paging system on a resident inpatient teaching service

Numeric pagers are commonly used communication devices in healthcare, but cannot convey important information such as the reason for or urgency of the page. Alphanumeric pagers can display both numbers and text, and may address some of these communication problems. Our primary aim was to implement an alphanumeric paging system. Continuous quality improvement study using rapid-cycle change methods. General Internal Medicine (GIM) inpatient wards at 1 tertiary care academic teaching hospital. All residents, attending physicians, nurses, and allied health staff working on the general medicine (GM) wards. We measured: (1) the proportion of pages sent as text pages, (2) the source of the pages, (3) the content of the text pages, (4) the pages that disrupted scheduled education activities, and (5) satisfaction with the alphanumeric paging system. After implementation, 52% of pages sent from physicians or the GM wards were sent as text pages (P < 0.001). 93% of pages between physicians were text pages, compared to 27% of pages from the GM wards to physicians (P < 0.001). The most common reason for text paging among physicians was to arrange work or teaching rounds (33%). The most common reason for text paging from the GM wards was to request a patient assessment or for notification of a patient's clinical status (25%). There was a 29% reduction in disruptive pages sent during scheduled educational rounds (P < 0.001). We successfully implemented an alphanumeric paging system that reduced disruptive pages on a GM inpatient service.

A Comparison of Two-Way Text Versus Conventional Paging Systems in an Academic Ophthalmology Department

Alphanumeric paging systems are unidirectional without prioritization capabilities. Newer electronic communication devices such as two-way text paging systems are capable of bidirectional paging and prioritization. While previous studies have evaluated alphanumeric paging systems in academic hospital settings, bidirectional two-way text paging systems have not been investigated. The goal of this study was to evaluate efficiency and impact on patient care delivery of a two-way text paging system compared to conventional one-way alphanumeric pagers. This unmasked, crossover prospective study was divided into three phases. In phase one, surveys were distributed to all ophthalmology attending physicians, residents, clinical technicians, and secretaries to assess the conventional alphanumeric paging system. In phase two, these participants used two-way text pagers without instruction (unstructured format) that they subsequently compared to the alphanumeric system with devised surveys assessing (on a scale of 0 to 100) time saved, increased daily efficiency, facilitation in patient care, and overall impression (helpfulness).In phase three, participants used a specific communication prioritization protocol (structured format) with the two-way text pagers with subsequent comparison and assessment with the same surveys. Compared to traditional alphanumeric pagers, new digital two-way text pagers were found to be statistically (p < 0.0001) more helpful by participants in all categories: as a time saver (80.33 vs. 56.95) p < 0.0001, increased daily efficiency (78.15 vs. 57.13) p < 0.0001, facilitation in patient care (78.79 vs. 56.95) p < 0.0001, and overall impression (helpfulness) (61.82 vs. 84.33) p < 0.0001. When compared to the alphanumeric pager, the two-way text pager was found to decrease subjectively call backs (73.6% to 45.6%, p < 0.0001), reduce interruptions of learning activities (43.63% to 26.6%, p < 0.0001) and enabled better patient care (59.8% to 42.2%, p < 0.0001). No significant statistical difference was found between the structured and unstructured system. Two-way text paging (structured versus unstructured guidance) was preferred over the conventional one-way alphanumeric paging system in every participant category. Two-way text paging is an effective alternative to alphanumeric paging, demonstrating saved time, increased daily efficiency, reduced call backs and interruptions of educational activities, and facilitation in patient care.