Reaching the end of the page: time to replace the outdated bleep
The pager-based communications system in hospitals is outdated, say Paul Volkaerts and Debbie Guy, who explain why getting rid of the ‘bleep’ can help hospitals transform the way they deliver services and improve patient care.
9 April 2013
The traditional pager-based system of communicating with medical staff in UK hospitals does not do enough to maintain patient safety and is no longer fit for purpose.
In an NHS under sustained pressure to improve quality and increase productivity, the standard ‘bleep’ system is quietly conspiring to drive inefficiencies and affect patient care.
Too often, the system is — silently — at the root of delayed, inappropriate or mis-prioritised treatment, with negative outcomes for patients. Yet the problem continues to go unnoticed, unmeasured and unchallenged. If clinicians knew the size of the problem and how easy it is to fix, they would certainly push for change. But familiarity with the bleep system, and the widespread culture of acceptance, is holding back progress.
The tipping point is fast approaching: if hospitals are to improve patient safety, increase efficiencies and deliver better health outcomes, they must move away from a reliance on dated communications tools and bring secondary care into the 21st century. An effective solution is not only out there, it is simple to use, painless to implement and delivers immediate improvements. The benefits are significant. But the cost of failing to act is even greater. A wireless system of call handling and task management can not only save money, it can save lives.
A good communications system is the backbone of hospital activity
and central to clinical task management. The optimal patient journey
depends upon different clinical teams, spread across a large area,
pulling together to deliver holistic, timely and appropriate
services. Communication is key. But evidence indicates that the
bleep pager, the most common mode of communication in hospitals, is
having a detrimental impact on clinical care. It’s time to replace
it with a new model.
In turn, clinicians responding to messages often struggle to achieve direct contact with the nurse that initially paged them. The likelihood of the ward nurse being busy at the time of a return call is high. The ensuing ‘telecomms tennis’ not only leads to increased delays in treatment, but it perpetuates a lack of ownership and accountability that creates uncertainty and affects patient outcomes.
Equally, the limited nature of paged communications means that messages lack crucial detail, giving clinicians no ability to prioritise tasks. When a bleep arrives — commonly interrupting other clinical activity — an HCP has no means of discerning whether a request is urgent or routine. On average, only 10% of bleeps are classified as urgent — but the clinician is powerless to make the distinction.
The bleep system is also one-directional — forcing users to
contact a specific individual. This individual may already be
engaged on other time-consuming clinical activity and out of
circulation. Meanwhile other clinicians who are able to respond
immediately remain oblivious to the need. The bleep does not allow
the full workforce to be leveraged. It provides no visibility to
allow a hospital to direct its staff towards priorities, as there is
no real-time information to establish what individuals are doing at
any given time. This drives inefficiency, fails to maximise
resources and delays patient care.
Out of hours care
The problems are exacerbated in ‘out of hours’ care (OOH) when hospital resources are significantly depleted. On average, a hospital with 750 in-patients will deploy around 250 clinicians during core hours. But out of hours, whilst the volume of in-patients remains the same, the number of clinicians can drop to as low as five. OOH clinicians can typically expect to receive up to 150 bleeps during a standard shift — but with resourcing at a minimum, the current system’s inability to differentiate between critical and non-urgent activity makes effective task management an impossible exercise.
What’s more, it exposes acute patients to a potential treatment lottery. With 75% of annual hospital care classified as OOH, the challenge of maximising limited resources out of hours is ubiquitous across secondary care.
Current methodology is open to the miscommunication of clinical requirements. This risk is particularly heightened during the crucial shift handover period, when task allocation and the communication of clinical information from one team to another can be prone to inaccuracy. Miscommunication can not only lead to inappropriate treatment, evidence shows it can also lead to patient fatalities.
Despite this, the bleep system lacks an audit log to document
communication. When patient safety incidents arise, there is no way
of evidencing the clinical discussions that took place. Hospitals
must do more to ensure that clinicians have the right tools to
support their work. The bleep lacks accountability and governance
and carries no relevant patient information to help staff prioritise
and make informed decisions. This inevitably leads to increased
incidents and failure to rescue patients.
The cost of maintaining an archaic communications system is
significant. Delays to treatment — or indeed to hospital discharge —
not only lead to extended bed stays at increased expense, but they
also carry the risk of patient deterioration and, in some cases,
death. But the communications problem silently plaguing NHS
hospitals can be fixed quickly, painlessly and effectively.
Under this simple model, patient-directed tasks from ward nurses are directed through a coordinator who provides a triage function to allocate clinical tasks. These hospitals have quickly seen significant improvements in efficiency and information flow — leading to a reduction in untoward incidents, length of stay and peri-arrest calls. One hospital reported a 70% reduction in clinical incidents since the system was implemented.
Bleeping out the bleeps
NHS trusts can no longer afford to be stymied by a communications system that was built for a different age. If hospitals are to improve outcomes and meet QIPP targets, clinicians must change the embedded culture where outdated communications tools are routinely accepted.
Technology is letting healthcare, and patients, down. But the problem can be easily fixed. We’re reaching the end of the page. It’s time to get rid of the bleeps.
Paul Volkaerts is Managing Director at Nervecentre Software
Debbie Guy is Director of Clinical Operations at Nervecentre Software.