734 - Improving On-Call Communication through the Implementation of a Secure Text Messaging System

Poster Number: 734
Publication Number: 734.154

Simonne L. Horwitz, The Hospital for Sick Children, Toronto, ON, Canada; Sruthi R. Thomas, University of Toronto, Toronto, ON, Canada; Karim Jessa, University of Toronto Temerty Faculty of Medicine, Toronto, ON, Canada; Shawna Silver, The Hospital for Sick Children, Toronto, ON, Canada; Gabriel Tse, Stanford University School of Medicine, Palo Alto, CA, United States

Background: Effective communication is integral to patient safety. At our institution, nurses contact on-call General Pediatrics (GP) residents through a paging system. Using paging for non-urgent questions may interrupt clinical workflow, a recognized patient safety risk, and contribute to “pager fatigue” and resident burnout. Many hospitals have adopted secure text messaging systems (STMS) to replace pagers but these are often implemented without guidance or measurement of user satisfaction and typically require integration with third party vendors, thereby increasing costs.

Objective: To improve resident- and nurse-reported satisfaction with on-call communication methods and to reduce the number of non-urgent pages for GP residents on call by leveraging existing functionality within our electronic health record (EHR)[SH2] to implement an STMS.

Design/Methods: We developed and implemented an algorithm for the appropriate use of STMS (Figure 1) with multidisciplinary stakeholder input. Surveys were sent before and after STMS implementation to nurses and residents to assess satisfaction with on-call communication methods. Using hospital switchboard data, we retrieved the number of pages received by on-call GP residents before and after STMS implementation.

Results: Pre-intervention, both nurses and residents thought that pages negatively impacted their workflow (11/19 (58%) and 24/29 (83%), respectively) and were dissatisfied with the paging system[SH3]. Post-intervention, 16/17 nurses (94%) felt that STMS are a more effective way to communicate with residents, with 14/17 nurses (82%) noting improved satisfaction with on-call communication[SH4]. Similarly, 11/12 residents (92%) agreed that STMS are a more effective communication method and reported improved satisfaction on call. There was a 60% reduction in the number of pages received by residents on call, averaging 8.6 and 3.5 pages per on-call shift before and after STMS implementation, respectively (Figure 2).

Conclusion(s): In addition to decreasing the number of pages received by on-call GP residents, both residents and nurses agreed that STMS are a more effective means of communicating about non-urgent patient care issues and reported increased satisfaction compared with paging systems. These results suggest that the use of communication algorithms when implementing STMS may improve both communication quality and satisfaction. Leveraging existing EHR functionality results in decreased complexity, streamlined workflows, and cost avoidance.