Turning the "Page" Again: Decreasing Inappropriate After-Hours Pages.

Area of Science:

• Urology
• Healthcare Management
• Patient Communication

Background:

• After-hours pages to on-call residents can disrupt patient care and workflow.
• A significant percentage of these pages are often inappropriate, indicating a need for process improvement.
• The University of Minnesota Department of Urology aimed to reduce these disruptive pages.

Purpose of the Study:

• To decrease the number of inappropriate after-hours pages by 50%.
• To identify sources of inappropriate pages and implement targeted interventions.
• To evaluate the effectiveness of these interventions on page reduction.

Main Methods:

• Documented after-hours pages to on-call urology residents over 9 weeks (Phase I).
• Pages were reviewed by independent reviewers to determine appropriateness.
• Three interventions were developed targeting floor nursing, patient calls, and call triage centers, followed by a 6-week implementation and 9-week data re-collection (Phase II).

Main Results:

• Initially, 52.7% of pages were inappropriate, with the highest proportion (90.9%) originating from the call center.
• After interventions, the mean number of pages per shift decreased from 8.9 to 6.0.
• Inappropriate pages per shift decreased by 68.4% (P < .0001), exceeding the 50% reduction goal.

Conclusions:

• Improving communication with nursing staff, patients, and call center personnel effectively reduced inappropriate after-hours pages.
• The implemented interventions led to a 68.4% decrease in inappropriate pages, surpassing the initial objective.
• Further research is recommended to assess the long-term sustainability of these improvements.