Presented by Aidan Gill oncall

1. from
North Shore Pilot Trial
Staff Feedback:
‘This is one of the best things they’ve done in
this hospital’ – Ward Nurse
‘They trial all sorts of things in the wards, but
this one should stay’ – Ward Nurse
‘It makes us more efficient. Nurses know
we’re around and we’re able to respond back.
It’s so good, saves so much time.’ - Doctor

2. Hospital Paging Systems
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Used in every hospital in NZ and Australia
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Contact Number Paging
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Contact number only, no indication of urgency
Doctors stop what they’re doing to find a phone and ring back
Nurses wait for ~10 minutes, pages often not returned
Text Message Paging
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100 character limit, 2-3 min delay
No acknowledgement of delivery
No easy way to reply
‘mrs lee- shin has fall, alert, 0bs n/s 1hr 100, bruise on lt hip.
denied pain, pls r/v tka ann 3372’ – Ward Page, 99 chars

3. Task Management Systems
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Task Manager, SPADE, Clinical Task List
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An intranet based list of non-urgent tasks
Must be checked regularly every hour, even at night
Message delivery can be an hour or more later
Only used for 20% of tasks, everything else is via text page
iBleep
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SMS based, accessed via Britain on PDAs
Trialled at WDHB with limited success
Not seen as an improvement on pagers

4. (Note: Fictional pages, for demonstration only)

5. Waitemata Smartpage Trial – January 2013
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22 Doctors, 180 Nurses over four weeks
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Preconfigured Smartphones
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Kept in the telephonists office
Ward interfaces
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6 medical wards – CCU, CVU, SSU, Ward 3, 6 and 10
1 medical house officer – the Med C H/O
1,380 pages
Each ward given login details and a shortcut on the desktop
Anonymous online post trial survey
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With the help of Brian Cusack and Dave Parry from AUT

6. Communication Patterns
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More information being sent with each page
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Rapid page acknowledgments and return phone calls
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Median response time of 15 seconds from sending
Patient care questions are often answered straight away
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Average of 166 characters (max 532), opposed to 77 with text paging
Full set of patient and nurse details, plus vital signs and NEWS in 20%
Previously these would wait until a doctor arrived on the ward
Zero repeat paging by week 4 of the trial
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No stress over whether a page has been delivered
‘They get back to us a lot quicker now. We used to get very
annoyed when they didn't get back to us.’
‘When they ring back they ring back straight away. It’s almost instantaneous.’

7. Communication Before and After
‘mr smith wd6, bp 79/40 manual, p now 104,
sats 98, asympt, pl r/v news 3’
(72 characters)
(850+ characters)
Note: Names and patient identifiers changed

8. Post Trial Survey
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Anonymous online feedback – 74 nurses, 17 doctors
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Communication
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100% of nurses found it easier to portray how unwell a patient was
94% of doctors found that nurses were easier to understand
100% of doctors found Smartpage to make handover more accurate
Response times and workflow
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100% found Smartpage improved communication
100% wanted to continue with the system
98% of nurses felt doctors were responding faster
76% of doctors felt they could complete tasks faster than before
Time Saved
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Doctors – reported time savings – 10-15 minutes per hour

9. Paging Systems Comparison
Very Good
Good
Series1
Series5
Neutral
Series2
Series3
Bad
Series4
Very Bad
1
2
3
4

10. Staff Feedback
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5 pages of written and verbal feedback
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‘It’s so good. Sometimes doctors change teams and you don’t know.
The other day I paged 3 times and didn’t hear from the doctor for
hours only to find out it was the wrong person. You just don’t know
that messages are sent, you have to page again. That wouldn’t
happen with Smartpage.’ – Nurse
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‘This is an excellent device, it makes on calls smoother and less
stressful, and lets you focus more on tasks at hand. It makes your
job easier, and improves communication with nursing staff.’ –
House Officer
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‘This is one of the best things they’ve ever done in this hospital.’
- CCU Nurse

11. Extended Trial at Waitemata DHB
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From December 2013
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Now running on 13 wards
North Shore and Waitakere Hospitals
2 → 12 oncall house-officers
Every medical and surgical service
Independent DHB evaluation
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Analysis of 2,000+ page logs
Surveys repeated by the DHB
Independent focus groups

12. Additions since the Waitemata Trial
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Weekend Handover Lists
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Replaces paper lists cellotaped to whiteboards
Tasks on the phone when doctors log in
Record of tasks completed
Analytics and Workflow Reporting
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What tasks are sent and where they come from
Automated reporting and comparison of workloads
Tools for audit and service improvement
Extensive record of after-hours activity – not before available

13. Hospital Analytics and Reporting
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Workforce planning and the efficient use of doctors
Recharting and Warfarin extremely common
Quantify time spent on tasks such as IV lines and blood tests
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? Hospital Phlebotomists
Workload average over weekend - (min/average/max)
Day Doctor
Night Doctor

14. Questions
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‘It makes us more efficient. Nurses know we’re
around and we’re able to respond back. It’s so
good, saves so much time.’
– North Shore Hospital, Doctor
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‘Everyone on this ward really loves it. Doctors get
back to us quicker, and when they ring back they
ring back straight away. It’s almost
instantaneous.’
– North Shore Hospital, Nurse
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‘Now we know what's going on - at the moment
we keep paging and paging the doctors as we
don't know what's happening.’
– North Shore Hospital, Nurse