Is It Time To Dump The Pagers?

by Webmaster, Phoenix Medical Managerment, Inc.
Published on Feb 13, 2016

Pagers were first patented in the late 1940s for use in New York City’s Jewish Hospital and became a mainstream consumer device throughout the 1980s. Even though cell phones and smartphones have become widespread, these newer devices pose multiple unique challenges in medicine which is why pagers remain prevalent across the country.

While newer and secure technologies exist, paging still represents a prevalent form of communication in hospitals and they have their advantages.  In a hospital emergency—for example, if a patient had no pulse or very low blood pressure—a staffer would need to notify a full team of personnel as quickly as possible. The best option might be to use a pager.  In addition, it's well known that pagers have more reliable networks than cell phones, ensuring transmission of messages even in emergencies and while cell towers might cover 10-15 miles, a pager transmitter can cover 150 miles enabling communication in rural locations.   But they also have many disadvantages.  

Conventional wisdom attributes the persistence of pagers in healthcare to the glacial pace of change in hospitals and clinics. According to this view, hospitals are behind the times and reluctant to embrace new things, which might explain why a patient bounces from one care manager at one provider site to another care manager at another site and why medical records are still being faxed to post acute providers. 

Allison Bond describes another major disadvantage in her Slate article;  answering a simple yes-or-no question turns into a labor-intensive task. "To respond," she states, "I have to leave my patient’s bedside, find a landline phone, dial the right extension, and wait for someone to pick up. And sometimes the callback number I received sends me to the front desk on the hospital floor, at which point I have to wait to be transferred. All of this so I can give a one-word answer to a question."

According to a new study published in the International Journal of Healthcare Improvement, paging rates and volumes have not changed in 25 years. Researchers from Brigham and Women's Hospital in Boston analyzed a database of 1252 pages sent to the IM residents over 56 days encompassing 602 hours. They found that each physician was paged an average of 22.4 time a day, up to a daily maximum of 50.   Three-quarters of those pages were deemed clinically relevant and important, with 28% of pages coming from nurses, 16% from consultants and 15% from the lab. Almost all pages (82%) from nurses and consultants needed a response, but every response is a potential interruption in workflow. 

One of the more interesting outcomes of the study was the fact that residents who were geographically assigned to specific patient units had significantly fewer pages per day (19 vs 37).  A finding to consider during discussions about the benefits of regionalizing hospitalist teams.