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Paging issues resolving, thanks to collaboration

21 Jan 2018

By: Sarah Horn, Chief Nursing Officer

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Salem Health hospitalists, RNs and other key stakeholders have been addressing the problem of excessive provider paging. Using Lean problem-solving, they determined that lack of a standard was the root cause.horn

After months of collaboration, new standard work for both RNs and providers was developed to reduce unnecessary provider pages. The results of a two-week test of the standard work on D5 (Med Tele) were impressive. Unnecessary pages were almost eliminated on day shift and significantly reduced on night shift. 

The two most important standards that led to these results were:

1)      Hospitalists meeting face-to-face with the primary RN during rounding; and

2)      RNs following standard criteria for paging.

While this first test has been successful, each unit is distinctly different, so more testing will be done on IMCU and the General Medicine (4S) unit in January.

Comments on this process include:

Dr. Tate:  “I have been concerned about this problem for over a decade. Unnecessary paging interrupts our workflow and creates a patient safety hazard. This team worked collaboratively to prove my hypothesis that meeting with the RN face-to-face every time I round on a patient reduces unnecessary pages. This is further enhanced when RNs use standard criteria for paging. The results of this test make us all successful in providing quality patient care by minimizing waste and promoting more efficient and effective workflows for both the provider and the nurse.”

Dr. Batra: "This project is exemplary of the culture-shift I have witnessed firsthand in our organization. It was incredible to see a multidisciplinary team consisting of providers, nurses, Kaizen specialists and IT professionals come together and problem-solve this complex issue using Lean methodology. In addition to accomplishing their primary goals, initiatives like this improve provider and staff engagement, which is critical to sustain a culture of continuous improvement."

Dr. Loa: “This important issue has been addressed quite thoroughly by this interprofessional team. In addition to having standard work for both the hospitalist and RN, I have requested more enhancements to the admission order sets to give nurses more orders to use that will eliminate a need for a page.” 

Jessica Reese BSN, RN, CMSRN, Practice Council Chair: "The great thing about interprofessional projects using our Lean methods is that everyone has a voice and an opportunity to give input into the outcome. Nursing was eager to participate in this TOC and were excited to see standards and criteria were implemented that include their ideas."

Improvement work on various other paging issues continues through other venues. The Medical Staff Committee for Professionalism, which addresses provider paging response issues, is aware of concerns about undelivered pages, pages/texts sent to the wrong person, and the limitations of Web Exchange. The committee is actively promoting collaborative efforts among providers, nursing, administration and IS to address these problems.