Hospital Text Page Communications Remain Inefficient, Disruptive to Care

Experts compare existing paging methods within hospitals to "paved cowpaths."

Paging is constant in hospitals. Although technology is changing the nature of it significantly, there is still evidence that it remains inefficient, causing disruptions in workflow.

A new study out of the University of California San Francisco, published in JAMA Internal Medicine, found several flaws in text page messaging practices at one hospital that likely apply across many. The team looked at 575 unique messages sent between personnel at an academic tertiary care facility for their content and priority. The messages were sent through a web-based paging system that the researchers themselves had previously developed.

The largest portion (49%) of messages were sent by nurses, with physicians (75%) overwhelmingly being the recipients. The researchers read, coded, and wrote messages based on themes in the samples and used a codebook to code messages independently. Overwhelmingly, they found limited standardization and no real consistency in terms of urgency tagging (93% were marked nonurgent and 81% did not include an indicator of response urgency).

The typical messages they found were from nurses to physicians, listing a series of patient metrics and seeking further advice on procedures and tests. Many were introduced as “FYI” but actually contained questions, and many also listed incomplete health metrics (“ie, heart rate without blood pressure”) or used different terms to refer to measurements. Another study published in early 2016 found that despite overwhelmingly being clinically relevant, a majority of observed pages did require a response, “potentially leading to interruptions in workflow, and communication waste.” That study found that on average 7.7 pages were sent per patient, with a ceiling of 70 sent regarding one patient.

“Often, lack of clarity in text page messages introduced potential for delays or lack of understanding among team members,” the authors of the new University of California study observed. They wrote that text paging “has significant limitations for real-time communication in acute-care settings,” underscoring from other findings of that communication.

The authors hope that this work underscores the need to improve text paging protocols in hospitals, believing that the lack of clarity in information and importance could actually “undermine patient safety.” They conclude that their findings could be of use in the development of guidelines for more effective and efficient hospital communication, encouraging the use of standardized messaging and structured tiers of urgency for paging physicians.

Kenneth D. Mandl, MD, MPH, and Elaine Khoong, MD wrote an accompanying letter in JAMA Internal Medicine. They compare paging systems to essentially an old predecessor to the new “microcommunication” applications like Snapchat, but refer to HIPAA-compliant, medicine-specific text page platforms as something like “paving cowpaths.” They argue that a new generation of medical professionals born and raised in a world of obsessive microcommunicating will help in the development of better healthcare interchange, but also place a lot of hope in artificial intelligence. “Through Amazon’s Alexa, Apple’s Siri, and Nuance’s Dragon, spoken microcommunications may soon be interpreted understood, and transformed even before they reach their recipient,” they suggest.