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What the bleep?

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


 

PHOTOGRAPH BY ANDREW TOLSON

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.”


 

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