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Less is More

July 17, 2009

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By Alisa Kim

The "if it ain't broke, don't fix it" mentality that can mire large organizations in stagnation and inefficiency doesn't sit well with Dr. Brian Wong.

Wong is a physician in the division of general internal medicine at Sunnybrook Health Sciences Centre and an associate scientist at Sunnybrook Research Institute who specializes in patient safety and quality. His research on hospital paging errors has just been published in the Archives of Internal Medicine.

For over a year, Wong studied the hospital's system of paging doctors, focusing on paging errors and ways of reducing them. Although hospital paging errors are not considered headline news, the importance of timely responses to medical complications certainly is. "Paging error is a serious problem, but one that is not widely reported," says Wong. "Long delays may lead to serious medical problems."

In his analysis, Wong found that one in every seven pages was sent to a doctor who was not on duty, which he defined as an error for the purposes of the study. Of these, Wong found that one-third of the messages involved medical issues that needed to be dealt with within one hour, while 15% of the pages involved situations that required immediate action.

Paging errors contribute to delays in responding to medical problems as nurses usually contact numerous people before reaching the appropriate physician. Compounding the problem is the difficulty in keeping physicians' contact information up-to-date when pager numbers are located in various places throughout a ward.

To address this issue, Wong devised a new centralized paging system—a pilot program on one of the general medicine wards—wherein nurses would summon residents from any computer terminal on the ward. Pager numbers were removed from other locations and could only be accessed using the hospital's "Smart Web" computerized paging program, which was linked to physicians' schedules and updated regularly. He then ensured that each of the four physician teams had a resident responsible for fielding all pages during a particular shift. When nurses sent pages to any of the four teams, the messages were redirected to the resident scheduled to respond to the pages during that time.

The impact of these reforms is being studied. One benefit of this new system is that it does not require new investment in equipment or technology. "We weren't taking advantage of its capabilities," says Wong of the "Smart Web" software. "The beauty of the [new] system was that no new purchases or upgrades needed to be made. It was simply a matter of reorganizing the information that was there and making sure it was up-to-date."

Last July, all four wards of the division of general internal medicine implemented the new paging system. While he is hopeful that it will be adopted throughout the hospital, Wong recognizes that an openness to change, particularly from the hospital's leadership, will be required. "It's an important next step for all nursing wards, including long-term care wards. It involves a shift in philosophy of how paging is done."

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