Development and implementation of paging and escalation guidelines to improve interprofessional communication on surgical units.

Abstract

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. 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. 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. 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.