What the bleep?

Pagers are slow, unreliable, and a reason for hospital deaths



Dr. Dante Morra likes to say that “in the 1990s, the only people who used pagers were gangs and doctors.” His punchline: “Now, it’s only doctors. The gangs have moved on.” Danielle Kain, a medical resident in Halifax, recently became one of those doctors. At the start of her residency, she was assigned a basic pager—“a big, clunky, ’90s-style thing . . . not quite as big as a deck of cards.” Now Kain says she gets paged for “anything from ‘this patient is nauseated’ to ‘this patient is complaining of chest pain.’ ” Either way, she drops what she is doing and runs to the nearest phone.

There are few professions where the sound of a beeper still inspires panic. A decade ago, Motorola, the industry king, announced it was bowing out of the pager biz because of lagging profits. Tech writers penned obituaries for the corporate toy. “Death of the Pager?”, mused Forbes in 2001.

But hospital doctors remain holdouts. And they shouldn’t, says Morra, medical director of the Centre for Innovation in Complex Care at Toronto’s University Health Network (UHN). To Morra, the pager—“used in nearly every Canadian hospital,” he says—is not a benign technological relic, but a leading cause of preventable hospital deaths. He’s not alone. A growing number of doctors are calling to do away with what they say is a dangerously dated device. Hospital communication “is very, very complicated,” Morra muses. So “why are we using 1950s technology?”

The answer, in part, dates back 10 years, when engineers worried cellphones would interfere with hospital machinery. In 2007, a study by the Mayo Clinic in Minnesota showed that “normal use of cellphones results in no noticeable interference with patient care equipment.” Still, the habit has stuck.

A study Morra released last year, with doctors at Sunnybrook Hospital in Toronto and Toronto General Hospital, showed 14 per cent of pages at those hospitals were mistakenly sent to physicians who were “off duty and out of the hospital.” Almost half were later judged to be “emergency or urgent.” Because nurses never know if pages are received, Morra says, time is lost waiting and trying again. When a page does arrive, doctors just see a four-digit extension number on a screen. They have no way to assess how urgent the matter is—“if that’s the family member here to talk, or another patient is 10 minutes away from dying,” says Morra.

As early as 2006, studies at institutes like the Yale School of Medicine showed switching to cellphones cut error rates and delays. And on the Facebook group Bleep Etiquette, some 12,000 junior doctors grumble about the “bleep-and-run”—when nurses page them, but don’t wait to receive return calls. As for why so many remain unconvinced, Dr. Brian Wong, a doctor at Sunnybrook and a co-author of Morra’s study, says pagers get better reception and that critics worry about privacy, with doctors storing patient information on their phones. But he cites cost as the main issue.

Morra, for his part, blames “bureaucracy.” For him, the obvious solution is smartphones. He recently conducted a trial whereby UHN doctors were given BlackBerries. He says the switch had “a dramatic effect on the quality of care, and the speed of workflow.” Doctors can send detailed messages, forward test results to other doctors, or contact teams of people at the same time. They can tell nurses they’re on the way, or answer questions without leaving their patients’ bedsides.

Still, across North American hospitals, the pager is entrenched. At Sunnybrook, Wong says doctors—who must pay for their own device, be it BlackBerry or beeper—often choose the latter. (He carries both.) And for residents, being handed a pager is still a rite of passage. Arkadiy Shats, a pager repairman in Brooklyn, N.Y., says in the “good days” his team repaired 50 to 60 pagers a day. Now he stays afloat because of the boxes of busted pagers he gets from hospitals in the state.

These days the move is not away from pagers—but toward more sophisticated, alphanumeric pagers, which allow text messaging but are not as complicated as smartphones. Rob Graham of PageNet Canada says products like PageNet’s “two-way-wireless email pagers” are in demand by doctors. Wong, too, argues for alphanumeric pagers, which he introduced in a pilot project at Sunnybrook.

But Morra says it’s not enough. Hundreds of thousands of people die in North America each year because of hospital error, he insists. “The most common errors have to do with communications,” he says, and pagers are often a silent cause. It’s like “a 747 crashing every single day into the ground,” he sighs, “that nobody’s doing anything about.”


What the bleep?

  1. “…Hundreds of thousands of people die in North America…”

    This is a ridiculously false statement and being a nurse I don't believe it. Here's why.

    First of all, if someone is in critical condition and a doctor has to respond, a hospital “code” is announced over the P.A. system so that many doctors, not just one, respond to someone dying.

    Secondly, it's the nurses, not just one doctor, who work with many health professionals, to save someone's life in a code.

    • I think you are probably one of those page and run type of nurses that never waits for the call back. you make me sick

      • I don't trust doctors anyway

    • Tony, I agree that in times of absolute critical need a code will bring any variety of physicians, RTs, RNs, and code carts running. I have seen personally, and can think of many more situations of the like, where time-sensitive issues are held up due to slow communication. I.E. chest pain, the ECG is done but no physician is present to order the patient to the cath lab; K + of 5.7 and the patient is minutes away from a potentially deadly arrhythmia, a little kayexelate given soon enough could remedy that; and even a patient who is not protecting their airway and is nauseated, a little prokinetic could prevent aspiration and intubation. These situations are all not worthy of a "code" but are time critical for sure and waiting 15 minutes for a page back could make a lot of difference.

      BTW, if you couldn't tell I'm also a Nurse. One who believes that technology could help us better care for our patients.

  2. This isn't about pagers, it's technology adoption in healthcare in general.

    Name me another industry that has important critical records in some dusty manila envelopes locked in a filing cabinet? Pagers? they are but one piece of the disaster that is healthcare when it comes to using this kind of technology.

    They are the last ones to be dragged kicking and screaming out of the 1970's. I'm sure they'll get there eventually, but smart people are taking bets that it may take another decade at least.

  3. Yes, pagers are obsolete – the electronic equivalent of a teletype machine. But ironically, many people with cell phones use them exactly the same way – for texting. I've never understood it. Why buy a device that can be used for remote conversation, and use it instead to send typed messages?

    • That's a great question. First of all – text messages are a very low priority channel in the cellular network – SMS's get delayed or lost. When the network is congested – these are the first channels to be affected, because they are sharing resources with the voice channels. You just cannot rely on SMS's for mission critical communication.
      Also – pagers offer more than text messages.
      With pagers – you don't have to provide your patients your real phone number. It is known that you only respond when you choose to – unlike text messages. You can keep you pager on vibrate or alert even when you put your phone on silent – you know that pages are at a higher priority. The pager will alert you until you acknowledge it, reminding you over and over again of unread pages. Your phone doesn't do that! You can also read the page with a single click of a button – very simple, unlike phones with text messages. You lose all of these advantages and more when you forgo your pager and switch to a phone!
      But – Onset's Advanced Paging leverages a very reliable communication channel (NOT SMS), adds a separate inbox on the device for pages, overrides profile settings to make sure you get your alerts, and reminds you until you acknowledge! No need to carry two devices! http://www.onsettechnology.com

    • so, by this logic, text only email messages are same? in most advanced asian nations, we use blackberries for secure, encrypted communications ~ even sensitive medical information. time to get with the times!

  4. I worked at Sunnybrook for some time and am astonished to learn physicians have to pay for their own pagers.

  5. Since this was already mentioned, let me just reiterate it. Hospitals are known for having little to no cellular coverage. People, especially doctors are aware of the existence of cellular phones, and how advanced it has become. In fact, it is so advanced that anyone can have one. This brings us to the fact of professional distinction. Let's face it, there are time when calls made to a cellphone are ignored, because it would be thought of as nothing but a social call. High quality pagers give a sense of urgency, because of the industry that it is used for/ No one would page you just for a social purposes. Let face it, we blame technology for mishaps, when in fact technology only runs through human fuel.

  6. Page and run? Do Drs think nurses have the time to wait at the phone? We probably have to run because the patient is needing care! We are not hand maidens any more!!!

  7. This article is over 2 years old now, and we’re finally starting to see the tipping point heading into 2013. What the industry needed is now here, which is the wide adoption of smartphone technology, with over 90% of Physicians now carrying a smartphone. A year ago we were working with customers who identified this need, and it’s the reason why we started SmartPager, a Smartphone based paging solution. We no longer need to follow the ‘Page and Pray’ approach for critical messaging. (http://www.smartpager.net)