I wrote about good, old-fashioned pagers yesterday. They are very old, yet reliable technology. But these days, smartphones are all the rage. People walk around everywhere, staring at them. Are they useful in a hospital setting?
These days, 90% or so of healthcare providers carry a smartphone. They can transmit and receive much more information than a pager ever could. Would trauma team members at a Level I US trauma center find them valuable? The University of Arizona, Tucson sent a questionnaire to surgeons, residents, and midlevel providers rotating through their trauma service asking them a series of 31 questions about use of these devices.
Here are the factoids:
- 50 people completed the survey, most of whom (40) were residents. It appears that everyone was forced to return it.
- 94% were in favor of using it for communications
- 78% found it easy to use and user friendly
- 98% believed that it improved speed and quality of communication
- 98% believed it improved the accessibility of team members
- 90% felt that it improved physician response time
- 4% believed that it could not be used due to HIPAA regulations
Bottom line: This is a good example of an unscientific study dressed up to look a little scientific. And it essentially confirms the bias of the researchers. Nonetheless, it is an indicator of where we’re heading with in-hospital and out-of-hospital communications. The days of good, old-fashioned pagers and walkie-talkies are rapidly waning. Smartphones, and whatever follows (Google Glass?), are rapidly replacing them. The only obstacles now are ensuring good signal strength deep inside hospital buildings, and being ever mindful of HIPAA requirements.
Reference: Improving communication in Level I trauma centers: replacing pagers with smartphones. Telemedicine and e-Health, 19(3):150-153, 2013.
People who work in hospitals, particularly physicians, physician assistants, nurse practitioners and residents are throwbacks who still use old-fashioned paging technology. My colleague, the Skeptical Scalpel, recently lamented this fact in one of his blog posts. But they do seem to be a necessary evil, since cellular coverage is often limited deep inside of buildings.
But how much to trauma professionals get paged? An oral presentation at the recent Congress of Neurological Surgeons described a study that monitored paging practices between nurses and neurosurgical residents.
Medical students were paid to follow neurosurgical residents during 8 12-hour call shifts. They recorded the paging number and location, priority, and what the resident was doing when paged. The results were enlightening but not surprising:
- 55 pages were received per shift, on average, ranging from 33 to 75
- An average of 5 pages per hour were received, with a range of 2 to 7
- A substantial number of pages were received during sleep times (4 per hour)
- It took an average of 1.4 minutes to return the page
- 68% of pages were non-urgent
- 65% interrupted a patient care activity
- An average of 1.1 hours was spent returning pages per shift
Bottom line: Yes, we are throwbacks using an old technology. But it does serve us well. Unfortunately, it’s an old technology being used in an inefficient manner. I recommend that nursing units make it a practice to maintain a “page list” of nonurgent items. The trauma professional can then stop by or call each unit periodically (every 2 hours or some other appropriate time interval) and deal with all of them at once. Obviously, urgent and emergent problems should still be called immediately. This will ensure that routine issues are taken care of in a timely manner and the trauma pro can attend to their other duties as efficiently as possible.
Reference: Oral Paper 113: An Observational Study of Hospital Paging Practices and Workflow Interruption Among On-call Junior Neurosurgery Residents. Presented at the Congress of Neurological Surgeons 2012.
The September newsletter is now available! Click the image below or the link at the bottom to download. This month’s topic is Prevention.
In this issue you’ll find articles on:
- Motorcycle helmets
- Elderly falls
- Drug use
- Prevention map mashups
- And more!
Subscribers received the newsletter first by email last week. If you want to subscribe (and download back issues), click here.
Download the newsletter here!
I’ve been putting the Trauma MedEd newsletter together for nearly 2 years now. I’ve gotten several requests for information on back issues, so I’ve decided to publish an index of all the issues. Click any link to download the corresponding issue. If you want to subscribe and get new issues emailed to you first, click here. Thanks for reading!
The September issue was emailed to subscribers earlier this week. It will be released to non-subscribers in the blog next Monday.
To subscribe to the newsletter, click here.
A number of 9-1-1 calls (quite a few, I am told) are made, not for injury or illness, but because the caller needs help getting back into bed, chair, etc. It is also common that prehospital providers are frequently called back to the same location for the same problem, or a more serious one, within hours or days.
Yet another study from Yale looked at the details of lift-assist calls in one city in Connecticut (population 29,000) during a 6 year period. The town has a fire department based EMS system with both basic and advanced life support, and they respond to 4,000 EMS calls per year.
Some interesting factoids:
- Average crew time was about 20 minutes
- 10% of cases required additional fire department equipment, either for forced entry or for assistance with bariatric patients
- About 5% of all calls were for lift-assist, involving 535 addresses
- Two thirds of all calls went to one third of those addresses (174 addresses)
- There were 563 return calls to the same address within 30 days (usual age ~ 80)
- Return calls were for another lift-assist (39%), a fall (8%), or an illness (47%)
Bottom line: It looks to me that we are not doing our elderly patients any favors by picking them up and putting them back in their chair/bed. Lift-assist calls are really a sentinel event for someone that is getting sick or who has crossed the threshold from being able to live independently to someone who needs a little more help (assisted living, etc). Prehospital personnel should systematically look at and report the home environment, and communities should automatically involve social services to help ensure the health and well being of the elder. And a second call to the same location should mandate a medical evaluation in an ED before return to the home.
Reference: A descriptive study of the “lift-assist” call. Prehospital Emergency Care, online ahead of print, September 2012.