title: Text paging of surgery residents: Efficacy, work intensity, and quality improvement.
abstract: BACKGROUND
  Text pages can communicate important information but also disrupt workflow, which can affect the safety of patient care. The purpose of this study was to analyze the content, volume, and distribution of text pages received by general surgery residents and physician's assistants (PAs) using natural language processing (NLP).
  
  
  METHODS
  We studied text pages received by residents and PAs at a tertiary care teaching hospital from March to May 2012 using NLP. The number and content of pages were stratified by recipient seniority, surgical service, patient census, and patient location. Chi-square tests, t test, and analysis of variance were used to detect statistical significance.
  
  
  RESULTS
  We captured 48,202 pages. The average number (mean ± standard deviation) of pages per hour was 3.1 ± 2.2 for postgraduate year (PGY)-1s and 2.8 ± 1.9 for PAs (P < .0001). The greatest number of pages per day by Service was 86.1 ± 37.5 on the acute care surgery service. The most common paging topic was medications (18,444 [38.3%]) and the most common symptom was pain (6,240 pages [12.9%]). On services where patients were located near each other (regionalized), the number of pages per day per recipient per patient on census was almost half that compared with nonregionalized services (1.40 vs 2.43; P < .0001).
  
  
  CONCLUSIONS
  Residents receive a high volume of pages at this tertiary care center, particularly regarding medications and pain. Services with regionalized patients exhibit less paging need per patient. Initiatives to improve pain management and regionalize patients may streamline communication, decrease the number of pages, and increase patient safety.
authors.affiliation: Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
authors.forename: Ann D
authors.initials: AD
authors.lastname: Smith
authors.affiliation: Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
authors.forename: Marit S
authors.initials: MS
authors.lastname: de Vos
authors.affiliation: Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Smink
authors.affiliation: Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
authors.forename: Louis L
authors.initials: LL
authors.lastname: Nguyen
authors.affiliation: Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. Electronic address: sashley@partners.org.
authors.forename: Stanley W
authors.initials: SW
authors.lastname: Ashley
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001288:Attention; D003142:Communication; D003430:Cross-Sectional Studies; D004526:Efficiency; D005260:Female; D013502:General Surgery / Q000193:education*; D006801:Humans; D015994:Incidence; D007396:Internship and Residency / Q000379:methods*; D008297:Male; D061214:Patient Safety; D010823:Physician Assistants; D058996:Quality Improvement; D062606:Tertiary Care Centers; D060145:Text Messaging / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D055815:Young Adult