Paging the Right Resident the First Time on General Internal Medicine: A Quality Improvement Project

Background: Interprofessional hospital communication is vital for high-quality patient care. However, staff have reported that nursing pages are often sent to the wrong residents, leading to service delays, interruptions, and safety risks. The aim of this quality improvement project was to reduce day shift pages to general internal medicine (GIM) teams by 25% over 10 months by helping nurses page the right residents the first time. Methods: This study was conducted at a Canadian tertiary academic hospital and involved three GIM teams on seven inpatient wards. The Model for Improvement was used to explore root causes and redesign how nurses and switchboard operators contacted residents. Multiple change ideas were tested: posting daily resident assignments on digital monitors, redirecting switchboard pages to internal medicine residents, and forwarding pagers in learning sessions. The primary outcome was the average number of pages/team/week to GIM residents. Evaluation was conducted with statistical process control charts and qualitative feedback. Results: A total of 19,925 pages were reviewed from 226 resident shifts over 39 weeks. Average pages/team/week (Monday to Friday, 08:00 to 17:00) decreased by 38.3% (133 to 82) postimplementation. More nurses reported often or always knowing which residents were assigned to patients, increasing from 0% to 38.1%. Fewer residents reported often or always receiving pages about another resident's patient, decreasing from 50.0% to 26.7%. Conclusion: Quality improvement methods were used to streamline the paging process on GIM wards, resulting in fewer pages and improved communication efficiency.