Reaching the end of the page: time to replace the outdated bleep
The pager-based communications system in hospitals is outdated,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.
Pager communication does little to
support the needs of a hectic, fast-moving hospital environment.
Nurses paging busy doctors have no idea whether their messages have
been received — a signal blackspot can lead to a communication
failure that senders have no means of identifying. Likewise, since
devices have limited memory capacity, messages can quickly get
squeezed out of the system and missed by clinicians.
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
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
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.
This inability to manage
tasks in a timely and appropriate fashion is costly at every level.
Sub-optimal patient care can lead to unnecessary increases in
lengths of stay, placing greater pressure on resources and depriving
others of hospital care. Likewise, patients are exposed to the risk
of deterioration — with a delay in even routine interventions
capable of having serious medical consequences. A delay in
prescribing IV fluids, for example, can lead to a fall in Blood
pressure leading into renal failure and an extended hospital stay.
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
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
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.
Whilst the bleep
system is rarely — if ever — identified as the fundamental source of
a patient safety incident, evidence indicates that communication
errors are a factor in most incident reports. It is therefore
increasingly clear that a more effective communications system can
make a significant contribution to helping hospitals deliver safer,
more effective and efficient care. And if a simple change can yield
dramatic improvements, why accept inferior tools?
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.
In some parts of the UK, proactive trusts have implemented a
wireless system of task management that has helped empower
co-ordinated teams to manage clinical resources optimally.
Leveraging clinical workflow management software and mobile
technology over a medical-grade wireless network is already proving
to be effective in improving efficiency and patient safety.
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
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
Debbie Guy is
Director of Clinical Operations at