Differences in the response times of pages originating from the ICU.
OBJECTIVE
To determine whether the type of paging system causes significant differences in the response time by physicians to their pages in an ICU setting.


METHODS
Prospective cohort study performed in the ICU of two university-affiliated hospitals. All pages were classified by several different variables, including the type of paging system: direct paging if a nurse or hospital operator could directly place the page, or indirect paging if a nurse or hospital operator was required to contact the physician's office or a private answering service who would then independently contact the physician. The main outcome measure was physicians' response time, in minutes, to pages originating from the ICU.


RESULTS
During a 100-day period, 402 pages were sent and answered by 166 different physicians (87 attending physicians and 79 housestaff/physician assistants). The median response time for all pages was 3 min with a 25 to 75% quartile of 1 to 8 min. Twenty-five percent of the pages placed through an indirect system were associated with a response time of >/= 29 min. In a multivariate model with the response time dichotomized at >/= 15 min ("slow") or < 15 min ("adequate"), pages placed through an indirect system were answered significantly more slowly than pages placed through a direct system (p < 0.001; odds ratio, 4.36; 95% confidence interval, 2.05 to 9.29). Pages answered in an adequate amount of time were also associated with a significantly higher degree of overall nursing satisfaction with the care delivered by the physician in response to the specific page when compared with pages answered in a "slow" manner (p < 0.001).


CONCLUSIONS
Physicians who use an indirect paging system are significantly slower in their response to ICU pages when compared with physicians who utilize a direct paging system. These results may lead to improvements in paging systems used by physicians who care for patients in an ICU setting.
Moss
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Department of Medicine, Emory University School of Medicine, Atlanta, GA. marc_moss@emory.org
Trow
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Clardy
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D015331:Cohort Studies; D003237:Connecticut; D017598:Efficiency, Organizational; D005845:Georgia; D006747:Hospital Communication Systems / Q000706:statistics & numerical data*; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D010348:Patient Care Team / Q000706:statistics & numerical data; D011446:Prospective Studies; D013996:Time and Motion Studies