Clinical communications: When tech responds to junior doctors

Junior doctors are saving hours on shifts, safety has been enhanced, and nurses can easily see when clinicians will respond to deteriorating patients, following a clinical communications project at Lancashire Teaching Hospitals NHS Foundation Trust. Dr Omer Ali, internal medicine trainee and clinical informatics fellow, tells the story.

For a junior doctor, the typical working day can be stressful. This isn’t helped when you are bleeped almost continuously throughout the day, taking attention away from the patient in-front of you.

This was in fact the number one issue my colleagues raised, when senior hospital leaders joined junior doctor training sessions to listen and to understand frontline challenges.

With workloads becoming ever busier, colleagues reported excessive stress due to high volume of bleeps received.

The bleep wouldn’t tell them anything about why they were needed, and so doctors couldn’t prioritise and manage alerts – which could be for anything from the need for a routine prescription, to being urgently called to attend to a deteriorating patient.

This wasn’t just stressful – staff said it had become a patient safety concern.

Near constant bleeps were consuming significant amounts of scarce clinical time, with doctors needing to leave what they were doing with their current patient, to find a phone and call the ward. Often they would find that the nurse who had sent the bleep, as their then primary way of calling for help, had been called to another urgent matter.

Trust leaders took concerns seriously. An assessment was carried out by the trust to fully understand the impact bleeps were having. It found that nurses were equally frustrated, reporting difficulties using bleeps to get hold of the right doctor to attend patients requiring attention.

And it found that doctors felt they were at risk of causing medical errors because of bleep interruptions, as well as facing triage and handover challenges. A review of registrar and senior house officer activity revealed that the average junior doctor was spending as much as two to three hours on a typical shift, just responding to bleeps.

A decision to act

With the support of senior leaders, the trust sought to modernise its communications approach. The decision was in line with government policy around removing a reliance on pagers. But more importantly, it was an immediate way to improve the working lives of staff and to support the safe delivery of care.

Following a review of solutions available in the health technology market, the trust’s Chorley and South Ribble Hospital would become the first hospital anywhere in the Northern Hemisphere to deploy a system called Smartpage, a clinical communications app provided by Alcidion .

The secure clinical messaging system provided an ability to respond directly to concerns that had been raised.

The impact

In late 2021, I had the fortune of supporting initial go-live of the new system, which has seen remarkable results. Staff have reported significant safety improvements, and more effective ways of working.

The system works by allowing wards to visualise all available on call doctors and to assign tasks to the right person. That person then has the ability to manage the alert, with full context of patient needs.

Our junior doctors have said they face far fewer interruptions following deployment, that they are better able to prioritise patients, that handover quality has improved, and that more effective use of clinical time is being made.

On average two to three hours of each junior doctors’ time has been saved per shift. A survey of junior doctors conducted in 2022 found that junior doctors observed a 43% reduction in perceived medical errors and 60% improvement in flagging deteriorating patients since Smartpage was implemented.

Unlike the absence of information in a bleep, doctors have the patient data they need at their fingertips to allow them to prioritise tasks. They can message to tell nurses when they can respond, or to provide advice and courses of action before they arrive, and when necessary, reallocate tasks to less busy colleagues.

Rather than being continually bleeped, a doctor can deliver care to their patient without ongoing distractions.

Nurses have much more clarity when doctors will attend, avoiding the need to follow up repeatedly with multiple bleeps. And nurses have said they are empowered to provide better informed and safer care before help arrives.

We now also have detailed intelligence as a result of the system, allowing the trust to understand the types of tasks or issues escalated to the on call teams and consider changing shift patterns for when demand is higher.

Staff have told us they feel safer, with other benefits emerging too. The frequency of having to stay-on longer after shifts, in order to complete handover, has reduced. Staff can more easily get advice from senior colleagues. They face fewer interruptions during breaks. And they can more easily access urgent results.

In addition, the extensive time saved on each shift is releasing staff to respond to patients more quickly.

More and more parts of the trust, and organisations beyond, are calling to replicate the success achieved.

Led by junior doctors

This project has been led by junior doctors from the beginning. And unlike large and costly IT programmes, it has allowed us to respond to and address clinical needs in an effective and timely manner. As a junior doctor myself, I believe this is what all technology programmes in healthcare should be about.

In October 2023, Smartpage received Health Tech Newspaper’s Communication Tool of the Year award, recognising the work and benefits achieved at Lancashire Teaching Hospitals NHS Foundation Trust. Read the full announcement here.