Getting on the Same Page: A Quality Improvement Project to Reduce Overnight Nursing-to-Resident Physician Pages in an Inpatient Rehabilitation Unit
Quality Improvement/Patient Safety
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Many Physical Medicine and Rehabilitation (PM&R) residency programs utilize “home call” systems for nighttime coverage of inpatient services. In this system, trainees are expected to work at full capacity the following day after taking nocturnal call. While “on call,” trainees receive both urgent and non-urgent pages throughout the night, which disrupt sleep. To mitigate fatigue, improve hand-offs and improve timing of patient care, this study targeted reducing non-urgent overnight pages from nurses to home call PM&R residents between 11pm to 6am.
We implemented a prospective quality improvement study with interventions including holding “Getting on the Same Page” meetings to communicate interdisciplinary overnight paging expectations, starting a nightly nursing-to-resident hand-off sheet and hanging lists of suggested PRN medications in resident work rooms. 1,839 text-based nursing pages (366 pre- and 1,473 post-intervention) were studied for content, urgency and timing over a 17-month period.
Throughout the 13 months post-intervention, there was a 40% decrease in non-urgent pages between 11pm-6am, and the most common hour to be paged shifted from 11pm to 8pm. A linear model accounting for number of patients showed these effects were significant. Notably, the most common patient complaints overnight included pain, constipation, insomnia and nausea.
Residents “Getting on the Same Page” with nighttime nursing staff about communication expectations can reduce non-urgent pages between 11pm-6am with sustained effects for over a year. Encouraging residents to anticipate nighttime PRN medications and creating a nighttime nursing-to-resident hand-off sheet may also help perpetuate these effects.
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