Jim’s Thoughts  – Episode 2

Welcome back to my blog “Jim’s thoughts” where I aim to break-down and discuss current PA & healthcare news, and important clinical updates. This week I’ll be discussing my thoughts on February’s revelation by health secretary Matt Hancock, that hospital bleeps are to be phased out by 2021.

In late February this year, the health secretary Matt Hancock released a statement ordering the removal of pagers, also known as “bleeps”, from non-emergency communications by the end of 2021. Not only will hospitals have to phase out pagers by 2021, they are also expected to have full plans and infrastructure in place to ensure a smooth phase out by September 2020. This announcement was part of the ongoing work to bring the NHS in line with the ‘tech vision’ and ‘Long Term Plan’ strategies aimed at drawing the NHS away from outdated equipment and into the digital age.

So why does the government want to get rid of pagers? Well, there is only one remaining pager network in the UK – Capita PageOne, which serves all 130,000 pagers currently in use in the NHS. With a sole network provider (and a lack of competition), the cost of running and maintaining pagers is approximately £6.6 million per year and a single pager costs about £400 to the NHS. Cost plays a huge part in this decision, in an NHS that seeks to be ever more cost-effective versus increased demand for services. The Health Secretary, Matt Hancock, felt pagers were outdated, less secure, and slower than contemporary communication methods such as mobile phones and emails, and suggested this was the key reason for bringing about the end of the hospital pager.

In the 4 months I have spent as a Stroke Physician Associate since passing my national exams, I have held a bleep on most, if not all days. The bleep is a rapid communication tool, allowing for nurses on the Stroke unit to contact me should they have any questions, require patients to be reviewed if they have concerns, or simply to contact me if I’m off the ward, for example in the weekly MDT. Pagers are also important when acting as part of the cardiac arrest team – offering a simple and quick method to rapidly contact team members and alert them to the location of the arrest. In addition, pagers are hardy little devices – their batteries last far longer than the average mobile phone, they don’t break when dropped, and they operate on a separate network to modern mobile devices so often have better signal coverage – particularly in older hospital buildings. Overall, I can see that the bleep plays an important role in hospital communication flow, and therefore in-patient management.

In my experience, the main issue with the bleep is that it has no priority system accompanying it. For example, I could be bleeped twice within 5 minutes. The first bleep might be a nurse asking me to review a patient who has suddenly developed a fever and a NEWS score of 3. The second might be asking me to review a patient who has suddenly started complaining of crushing chest pain, radiating into the left arm and jaw. To the nursing teams, both are appropriate reasons for bleeping, and both are important, requiring medical review. However, I can’t attend both patients at the same time, so I must then make a judgement call about which patient I go to see.

Equally, I may be asked to bleep the medical registrar for advice. However, the medical registrar would also have their own patients to attend, and have various other bleeps coming in from other specialties – so how do they know to prioritise the incoming bleeps? Ultimately bleeps end up being answered in the order they were received, but this is an inefficient system and leaves prioritisation up to the person holding the bleep. This is fine if it is an experienced doctor/PA, but might be more difficult for the less experienced staff member.

So what alternatives are there to the bleep? A pilot scheme was trialled at the West Suffolk NHS Foundation Trust where pagers were replaced with an app called Medic Bleep. Medic Bleep looks, and feels, like WhatsApp (which has been sanctioned by the NHS for emergency use) but has enhanced functionality that meets General Data Protection Regulation and NHS information governance standards. Medic Bleep has been generally well received by staff, with praise being given for its ease of use and functionality. Senders write a text message with all required information and are able to receive notification when the message has been delivered and read. This potentially prevents workflow disruption by releasing staff from waiting for the returned telephone call of the old pager system. Medical errors may also be reduced through clear written instructions and clarifications that can be followed via an audit trial. Data from this trial suggested Medic Bleep saved nursing staff more than 20 minutes per shift, whilst doctors saw greater benefit with an over 50 minute per shift saving.

Whilst not a total replacement for the pager, Patientrack, as used by Harrogate and District NHS Foundation Trust, has helped make the pager a more efficient tool. Patientrack monitors and digitally documents patient vital signs in real time, automatically calculating their NEWS score. Patientrack then automatically bleeps the most appropriate doctor based on the NEWS score. For example, a patient who has suddenly become febrile but is otherwise NEWS scoring 1 would be directed to an FY1/junior PA. A patient who is NEWS scoring 8 would be immediately directed to the medical registrar/highly-qualified PA. Patientrack also allows for the attending doctor/PA to review the patient’s charts on a mobile device prior to arriving to see the patient.

Medic Bleep and Patientrack both show excellent promise but they aren’t perfect. Any solution that runs on a mobile or wifi-enabled device may be prone to signal “dead-spots” (especially in older buildings), experience network outages, suffer delays or back-logs of messages. Mobile devices could interfere with hospital equipment and whilst the pager system is aging rapidly, it is quick, reliable and ultimately it is effective.

Mr Hancock may wish for the end of the bleep, but until a universally tried, tested and accepted alternative is rolled out across the NHS, the pager might still have faint signs of life left in it yet.

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