Development and implementation of paging and escalation guidelines to improve interprofessional communication on surgical units
Introduction Suboptimal interprofessional communication in the surgical inpatient setting has important implications for patient safety. Our departmental quality committee identified numerous safety events resulting from discordant expectations between surgical floor nurses and surgical residents or...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2025-05-01
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| Series: | BMJ Open Quality |
| Online Access: | https://bmjopenquality.bmj.com/content/14/2/e002995.full |
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| author | Michael A Kochis Lynze R Franko Kathleen Swierzewski Alison Parmar Suzanne Algeri Rajshri M Gartland |
| author_facet | Michael A Kochis Lynze R Franko Kathleen Swierzewski Alison Parmar Suzanne Algeri Rajshri M Gartland |
| author_sort | Michael A Kochis |
| collection | DOAJ |
| description | Introduction Suboptimal interprofessional communication in the surgical inpatient setting has important implications for patient safety. Our departmental quality committee identified numerous safety events resulting from discordant expectations between surgical floor nurses and surgical residents or advanced practice providers (APPs) who serve as responding clinicians (RCs), and from reluctance to escalate clinical concerns. Alphanumeric paging is frequently used to communicate, but there are opportunities to enhance its effectiveness. This initiative sought to improve perceptions of communication and responsiveness between nurses and RCs by providing a shared language and set of expectations about the urgency of pages, appropriate responses and the process of escalation to other team members if necessary.Methods An interprofessional team of surgical faculty, nurses and residents solicited input from surgical floor nurses, operating room nurses, residents, APPs and attendings on their perceptions of communication barriers among team members via online surveys and focus groups. Guidelines were iteratively developed. They specify that every page should be classified as STAT, Urgent, Please Call or FYI. Each classification is associated with an expected response time and pathway for contacting alternative team members if no response is received. After 3 months of implementation on our hospital’s two main general surgery units, follow-up online surveys with multiple-choice and free-response questions assessed perceived impacts on communication and clinical care. Differences in categorical variables were assessed with χ2 tests, and free text was analysed inductively.Results After implementation, nurses reported favourable effects on communication, including significantly improved responsiveness during night shifts and timeliness from RCs during day shifts. Residents and attendings perceived the intervention to have overall neutral to mildly positive effects on communication.Conclusions Paging and Escalation Guidelines are a feasible approach to enhance the perceptions of communication between nurses and RCs by aligning expectations, streamlining responses and decreasing barriers to escalation. |
| format | Article |
| id | doaj-art-97b3bb3e478c4fd48e2f9613e39092e3 |
| institution | OA Journals |
| issn | 2399-6641 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Quality |
| spelling | doaj-art-97b3bb3e478c4fd48e2f9613e39092e32025-08-20T02:27:20ZengBMJ Publishing GroupBMJ Open Quality2399-66412025-05-0114210.1136/bmjoq-2024-002995Development and implementation of paging and escalation guidelines to improve interprofessional communication on surgical unitsMichael A Kochis0Lynze R Franko1Kathleen Swierzewski2Alison Parmar3Suzanne Algeri4Rajshri M Gartland5Massachusetts General Hospital Department of Surgery, Boston, Massachusetts, USAMassachusetts General Hospital Department of Surgery, Boston, Massachusetts, USAMassachusetts General Hospital Department of Surgery, Boston, Massachusetts, USAMassachusetts General Hospital Department of Nursing & Patient Care Services, Boston, Massachusetts, USAMassachusetts General Hospital Department of Nursing & Patient Care Services, Boston, Massachusetts, USAMassachusetts General Hospital Department of Surgery, Boston, Massachusetts, USAIntroduction Suboptimal interprofessional communication in the surgical inpatient setting has important implications for patient safety. Our departmental quality committee identified numerous safety events resulting from discordant expectations between surgical floor nurses and surgical residents or advanced practice providers (APPs) who serve as responding clinicians (RCs), and from reluctance to escalate clinical concerns. Alphanumeric paging is frequently used to communicate, but there are opportunities to enhance its effectiveness. This initiative sought to improve perceptions of communication and responsiveness between nurses and RCs by providing a shared language and set of expectations about the urgency of pages, appropriate responses and the process of escalation to other team members if necessary.Methods An interprofessional team of surgical faculty, nurses and residents solicited input from surgical floor nurses, operating room nurses, residents, APPs and attendings on their perceptions of communication barriers among team members via online surveys and focus groups. Guidelines were iteratively developed. They specify that every page should be classified as STAT, Urgent, Please Call or FYI. Each classification is associated with an expected response time and pathway for contacting alternative team members if no response is received. After 3 months of implementation on our hospital’s two main general surgery units, follow-up online surveys with multiple-choice and free-response questions assessed perceived impacts on communication and clinical care. Differences in categorical variables were assessed with χ2 tests, and free text was analysed inductively.Results After implementation, nurses reported favourable effects on communication, including significantly improved responsiveness during night shifts and timeliness from RCs during day shifts. Residents and attendings perceived the intervention to have overall neutral to mildly positive effects on communication.Conclusions Paging and Escalation Guidelines are a feasible approach to enhance the perceptions of communication between nurses and RCs by aligning expectations, streamlining responses and decreasing barriers to escalation.https://bmjopenquality.bmj.com/content/14/2/e002995.full |
| spellingShingle | Michael A Kochis Lynze R Franko Kathleen Swierzewski Alison Parmar Suzanne Algeri Rajshri M Gartland Development and implementation of paging and escalation guidelines to improve interprofessional communication on surgical units BMJ Open Quality |
| title | Development and implementation of paging and escalation guidelines to improve interprofessional communication on surgical units |
| title_full | Development and implementation of paging and escalation guidelines to improve interprofessional communication on surgical units |
| title_fullStr | Development and implementation of paging and escalation guidelines to improve interprofessional communication on surgical units |
| title_full_unstemmed | Development and implementation of paging and escalation guidelines to improve interprofessional communication on surgical units |
| title_short | Development and implementation of paging and escalation guidelines to improve interprofessional communication on surgical units |
| title_sort | development and implementation of paging and escalation guidelines to improve interprofessional communication on surgical units |
| url | https://bmjopenquality.bmj.com/content/14/2/e002995.full |
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