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Development and Implementation of Paging and Escalation Guidelines to Improve Multidisciplinary Communication on Surgical Units: A Pilot Study
Michael Kochis, MD EdM
1; Lynze Franko, MD
1; Kathleen Swierzewski, RN
1; Alison Parmar, JD MBE
2; Suzanne Algeri, DNP MS RN
2; Rajshri M Gartland, MD MPH
1
1Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 2Department of Nursing and Patient Care Services, Massachusetts General Hospital, Harvard Medical School, Boston, MA
Background: Our Department of Surgery quality committee identified numerous safety events resulting from discordant expectations between surgical floor nurses who send pages and clinicians who respond to them. This initiative sought to improve nurse-clinician communication by providing a shared language and set of expectations about the urgency of pages, appropriate responses, and process of escalation to other team members if necessary.
Methods: A multidisciplinary team solicited input from surgical floor nurses, operating room nurses, residents, advanced practice providers, and attendings on their perceptions of communication barriers via online surveys and focus groups. Paging and Escalation Guidelines were iteratively developed and implemented for three months on our hospital’s two main general surgery units. Additional online surveys assessed perceived impacts on communication and clinical care. Differences in categorical variables were assessed with Chi-square tests, and free text was analyzed inductively.
Results: The guidelines specify that every page should be assigned one of four urgency levels, each associated with an expected response time and a pathway for contacting alternative team members if no response is received. After implementation, nurses reported favorable effects on communication including significantly improved responsiveness during night shifts and timeliness from clinicians during day shifts. Residents and attendings perceived the intervention to have overall neutral to mildly positive effects on communication.
Conclusion: Paging and Escalation Guidelines represent a feasible, acceptable, resource-neutral approach to enhance communication by aligning expectations and facilitating escalation. Next steps include iterating the guidelines based on feedback, addressing barriers to promote uptake and sustainability, and scaling implementation.
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