Better Etiquette for Effective Paging (B.E.E.P.)—Improving Daily In-hospital Communications in the Pediatric ICU
Paging is a vital part of hospital care that allows prompt communication between physicians and other hospital personnel. Before this initiative, there was no standard way for nurses, respiratory therapists (RTs), or other members of the patient care team to send a page to physicians at our institution. With no standardization, a high volume of pages that physicians receive without structure could lead to decreased physician responsiveness, increased frustration from nursing and ancillary staff, and possible compromise to patient care. These issues can ultimately lead to impaired communication and inadequate information distribution, known as causes of patient care errors and significant preventable clinical errors.
Several studies assessed paging processes in the hospital environment and various settings among different specialties—pediatrics, internal medicine, general surgery, neurosurgery, in a Veterans Affairs academic teaching hospital, and an academic military hospital. Studies also show that a significant proportion of pages are considered nonurgent, which can distract physicians who then are unable to appropriately complete essential tasks, resulting in delayed patient care and a potential source for medical errors.
Our paging system consisted of alphanumeric paging. Physicians receive text pages from other patient care team members, either on a pager or on a mobile phone application (Spok mobile,, Spok Holdings, Inc. Springfield, Va.). Some nurses left only a phone extension number for the physicians to call back. When used efficiently, the alphanumeric paging system, which is compliant with the Health Insurance Portability and Accountability Act (HIPAA), has numerous benefits, including allowing physicians to prioritize pages, decreasing the disruption of patient care and other essential tasks, and improving working relationships between physicians and the rest of the patient care team. Residents and fellows in our pediatric intensive care unit (PICU) received almost 100 pages/d on average, mostly nonurgent updates, order clarifications, and for-your-information (FYI) pages, especially in the middle of the night. This project aimed to standardize the paging system while implementing “paging etiquette” guidelines and other interventions to communicate effectively with physicians through pages. We hypothesized that by using the Better Etiquette for Effective Paging (BEEP) bundle (standardizing the paging format, scheduling laboratory draw times, and using order clean-up sheets), we could safely decrease the number of pages received on the pediatric ICU resident pager by at least 15% without compromising patient care.
