C. J. Hendrix1, A. E. Graham1, J. J. Lu1, S. W. Chen1, T. E. Ju1, L. Rivas1, I. N. Haskins1, K. Vaziri1 1George Washington University School Of Medicine And Health Sciences,Department Of Surgery,Washington, DC, USA
Introduction:
Frequent non-urgent paging between nurses and physicians can lead to interruptions in patient care, physician rest, and also result in pager fatigue for the on-call surgery resident. Overnight on-call residents are particularly vulnerable due to high patient volume and decreased staff availability for support. Studies have explored how to reduce non-urgent pages between nurses and providers using collaborative education and protocols to determine which calls may be labeled as “non-urgent” and thus be deferred until more staff are available or until morning rounds. Recently, the use of checklists within the healthcare system has proven to enhance patient care and outcomes, particularly for surgical safety. This study aims to investigate the utilization of checklists at evening sign out to improve communication between nurses and physicians, limit the incidence of non-urgent paging, and help minimize resident physician work burden.
Methods:
A survey was provided to the nursing staff and surgery resident physicians to determine the most common calls made to surgical interns on overnight shifts. A list was compiled based on these survey results. This list was then given to surgery interns to track calls or pages received overnight. The results were used to identify the five most common preventable, non-urgent overnight calls. A list of these items was provided to residents and daytime nursing staff to be utilized at time of evening handoffs. Both physicians and nurses were encouraged to address these items for each patient prior to start of night-shift. Calls and pages were again logged following this intervention to assess the frequency of non-urgent, preventable calls and pages. Calls and pages were recorded in the middle weeks of February and March only on weekdays (from 6pm to 6am) to avoid weekend coverage confounders. A T-test was used for data analysis.
Results:
Of the 270 calls recorded during the pre- and post-intervention data collection period, 173 calls were for common, non-urgent matters. Pre-intervention, residents received an average of 19 (0.55/patient) preventable calls overnight. After the checklist was instituted, residents received an average of 9 (0.26/patient) preventable calls overnight with a p-value of 0.016.
Conclusion:
Implementing a handoff checklist prior to night-shift to address the most common preventable issues necessitating overnight pages significantly decreased the number of calls made from the nurses to on-call resident physicians at night at our institution. This pilot study suggests that handoff checklists and multidisciplinary sign out can decrease non-urgent calls which may help prevent pager fatigue and improve resident physician work burden.