An Hour in the Life of a Pager
I read an interesting fact the other day-- as many as 25% of all beeper pages were unimportant or unnecessary and actually interrupted patient care (citation below, if you care that much). That makes one heck of a lot of wasted time answering pages and trying to find a free phone.
What immediately came to mind was an incidence of pager-abuse not too long ago, when I was paged *1 (meaning STAT, or emergency) out of a patient assessment to the emergency room. As I had three patients in emergency at that time that were admitted and waiting for beds to become available upstairs, I rushed out of my assessment and ran to the nearest phone. The emergency? I had forgotten to sign a radiology requisition, and the patient was on their way to x-ray. Nice.
So I decided to conduct an experiment. Today I actually wrote down what I was being paged for every time my electronic leash went off. This lasted for little more than an hour before I couldn't keep up with it, but it was interesting while it lasted. Now keep in mind that during this hour I am trying to see three surgery consults in the emergency room with the help of two clinical clerks.
10:02am: The floor pages me to tell me that Mrs. W's urine output was low. I ordered a bolus of fluid over the phone.
10:04am: The emerg (two feet from where I was currently sitting) pages me to let me know my patient is waiting for me in emerg. Um, thanks. I know.
10:04am: Senior resident pages me to remind me that Mr. D's CT scan needs to be set up before lunch. Thanks, I know. I've done it already.
10:09am: Radiology pages me with results of an ultrasound on one of my patients.
10:12am: The floor pages me to tell me that Mr. P's PICC line fell out. I inform her that it didn't fall out, we ordered it removed last night because it was infected. She is satisfied with that.
10:12am: One of the clerks pages me from the other end of the emergency room to tell me he's finished assessing his patient.
10:12am: Who knows who this was? I tried to call it back three times and the line was busy. Don't page me and then get on the freaking phone!
10:19am: The floor pages me to ask if I'm sure that I want Mr. H's heparin stopped. Yes, I do. That's why I wrote the order "discontinue heparin".
10:21am: The floor pages me to tell me that Mr. Y has spiked a fever of 40.2. The nurse has given him Tylenol, but she just wanted to make me aware. Um, thanks.
10:34am: The floor pages me to tell me that Mr. L's nurse thinks that his abdomen is becoming more distended. I tell her I'll be up to look at it when I get a chance.
10:34am: Senior resident calls me from the OR to let me know that we'll be running the list with the staff (i.e. discussing the patients) after their next case. I agree to meet them. I wonder how the heck I'm going to get these consults done before then when my pager keeps going off.
10:40am: Hematology resident pages me to tell me about another consult on one of their patients. This day is not looking any better.
10:52am: Nurse from the floor pages me to ask me if Mrs. M's additional bloodwork can be done tomorrow morning when the tech comes back because she's a difficult stick. The bloodwork isn't urgent, so I tell her it's fine.
10:54am: Nurse from the floor pages me to tell me that Mrs. W's bloodwork showed that her INR (measure of how easily blood will clot) is too high. I change her dose of coumadin (drug that makes blood less clotty) for that evening.
10:57am: Another page from the ER (this time, 10 feet from where I am sitting) to ask if we're going to be sending one of our consults home. If I had time to deal with the consult between pages I'd be happy to answer the question.
That made 15 pages in the space of one hour. A page every four minutes, on average. Of these, maybe 6 were useful or necessary. This hour might not have been representative (I don't usually get THAT many useless pages in such a short period of time) but I'm now starting to understand why I can get through a 12-hour day without having time to eat or sit down and yet still feel like I've accomplished nothing.
There is good news, though. As of today at 6pm when I finally left the hospital, I am on vacation. For a whole week. Thank God.
Blum NJ, Lieu TA: The effects of paging on pediatric resident activities. American Journal of Diseases of Children 1992; 146(7):806-808.