THE SILENT TREATMENT: AN ANALYSIS OF WHY NO-ONE RESPONDED

Eric Martin, MD*1;Anunta Virapongse, MD, MPH2;Madelin Adames, RN, MSN3;Matthew Campo, MHA4;Ashley LaBree, RN3;Marcee Paul, MBA, BSN, RN-BC3 and Aimee Zak, RN3, (1)University of Colorado, Aurora, CO, (2)University of Colorado Anchutz Medical Campus, Denver, CO, (3)University of Colorado Hospital, Aurora, CO, (4)Universtiy of Colorado Health, AURORA, CO

Meeting: Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev.

Abstract number: 11

Categories: Communication, Research Abstracts

Keywords: , ,

Background: Lack of urgency indicators and receipt confirmation are two of several known alphanumeric paging limitations. To address absence of urgency indicators, a Priority Structured Paging (PSP) system that allowed nurses to communicate priority was adopted at an academic medical institution across multiple nursing units caring for a mixed patient type and acuity. Data recorded during PSP implementation provided information about pages, both numeric and text, that did not receive a response, hereafter referred to as “No Response” pages. Dedicated analysis was undertaken to assess the burden, elucidate the source, and determine the impact of PSP on No Response pages.

Methods: During a two-week pre-intervention phase, RNs on a medical, surgical, and a mixed step-down unit recorded multiple aspects of their pages on provided data forms. Pages that did not receive a response were noted with an “X.” After completion of a pre-intervention survey, RNs and providers were educated on how to use the PSP system. During the intervention phase, RNs tagged their page with their level of concern (911, 1, 2, or 3, corresponding to emergent, high, medium, and low priorities of the pre-intervention phase), and recorded similar variables as during the pre-intervention phase. “No Response” pages were again noted by an “X”. No Response pages were filtered from the collected data and analyzed.

Results: 278 (14.16%; n=2037) and 219 (8.98%; n=2440) No Response pages were recorded during PSP pre-intervention and intervention phases, respectively. PSP resulted in a statistically significant decrease in No Response calls (p<0.0000) that was dependent on priority (ꓫ2=14.92, p=0.0006). No Response occurrences were also dependent on nursing unit (ꓫ2=10.54, p=0.0051), driven by the step-down nursing unit, and service paged (ꓫ2=32.45, p<0.0000), driven by medicine and surgery services. No Response occurrences were not dependent on mode of page (numeric or text; ꓫ2=0.51, p=0.4742) or time of day (AM or PM; ꓫ2=1.08, p=0.3).

Conclusions: PSP decreased the burden of No Response pages. By providing RNs a timeframe to expect a return call, the observed decrease in No Response pages may be explained by: 1) RNs are less likely to record a No Response page if an expected time of response is present, thus decreasing repeat pages, and/or 2) providers are more likely to respond promptly to high urgency tagged pages. Regardless of cause, there is no evidence to support providers systematically ignore low urgency pages. In this study, the source of No Response pages was driven by a higher acuity nursing unit served by both medicine and surgical teams. Additional study of No Response pages should include automated data to more precisely track from where, to whom, and when No Response pages occur, as well as their impact on patient care.

To cite this abstract:

Martin, E; Virapongse, A; Adames, M; Campo, M; LaBree, A; Paul, M; Zak, A . THE SILENT TREATMENT: AN ANALYSIS OF WHY NO-ONE RESPONDED. Abstract published at Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev. Abstract 11. Journal of Hospital Medicine. 2017; 12 (suppl 2). https://www.shmabstracts.com/abstract/the-silent-treatment-an-analysis-of-why-no-one-responded/. Accessed July 15, 2019.

« Back to Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev.