using nnapps (nighttime nurse and physician paging system) to maximize resident call efficiency...
TRANSCRIPT
Using NNAPPS (Nighttime Nurse and Physician Paging System) to Maximize
Resident Call Efficiency within 2011 ACGME Work Hour Restrictions
Jason B. Young, MD, Aaron C. Baker, MD, Judie Boehmer, RN, Karen M. Briede, RN, Shirley A. Thomas, RN, Cheryl L. Patzer,
RN, Christina Pineda, RN, Gina Cates, RN, Joseph M. Galante, MD
University of California, Davis Medical Center
2012 Surgical Education WeekAPDS Annual Meeting
March 21, 2012
Background
ACGME: July 2011 Common Program Requirements:
Continued balance of:
Patient care duties Patient safety Overnight call schedule coverage Resident education, training and rest
Alertness Management / Fatigue Mitigation Strategies:
“Strategic napping”
Background
Paging Systems:
Valuable mode of communication
Yet frequent paging disruptive to:
Sleep fatigue medical errors, MVCs, impaired health Patient care Work rounds Resident education
NNAPPS
Development of New Nighttime Paging Strategy ― NNAPPS:
Daytime logbook (non-urgent pt care issues):
Checked by resident at 06:00, 12:00, & 18:00 Charge RN reviews periodically
Nighttime paging:
Nighttime pages from 19:00 to 07:00 screened by Charge RN
Emergent pages sent immediately Urgent pages batched appropriately Non-urgent pages deferred until am
Hypothesis
Implementation of NNAPS Will Lead to:
Improved RN and MD communication
Reduce non-urgent nighttime pages to residents
Maintain high standards of pt care
Methods Design:
Prospective study at University teaching hospital
Logging of pages by residents working overnight call shifts
Nightly b/t 20:00 – 06:00 over 2 month period
Urgency of pages determined by independent review of 2 observers
Participants:
PGY-1 to PGY-5 surgery residents
9 surgical services: General Surgery; Transplant; Burn; CT; SICU x 2; Trauma x
2; Surgery Consult
Methods Implementation:
Pilot phase: NNAPPS implemented onto General Surgery Ward Compared to non – NNAPPS wards
Transferability phase: NNAPPS implemented onto Transplant Ward Compared to pre – NNAPPS Transplant Ward data
Outcome Measures (Pre – NNAPPS vs. NNAPPS):
Comparison of mean: Non-urgent pages per night shift Total pages per night shift Total pages / pt during a night shift
Results – Pilot
Descriptive Characteristic No. (%)
Total Pages 637
Night Shifts 80
Hours 851
Patients 921
Pages Originated by RN 406 (64%)
Results – Pilot
Descriptive Characteristic No. (%)
Urgent Pages 335 (53%)
Non – Urgent Pages 154 (24%)
New Order 238 (37%)
Patient Assessment 158 (25%)
No Action 219 (34%)
Non – Urgent 117/219 (53%)
Results – Pilot
OutcomeNo NNAPPS (Mean ± SD)
NNAPPS(Mean ±
SD)P – Value
Non-Urgent Pages/Shift
2.49 ± 2.56 0.05 ± 0.22 < .001
Total Pages/Shift 10.15 ± 5.00 1.45 ± 1.36 < .001
Results – Pilot
Average Pages Per Patient During Night Shift By Service
0.13
0.48
0.31
0.79
1.10
1.26
0.900.80
0.00
0.50
1.00
1.50
2.00
2.50
GeneralSurgery
Burn CT SICU 1 SICU 2 Consult TraumaWard 1
TraumaWard 2
Service
Averg
a P
ag
es P
er
Pati
en
t
*
*P< .05
Results – Transplant Ward
OutcomePre NNAPPS (Mean ± SD)
NNAPPS(Mean ±
SD)P – Value
Non-Urgent Pages/Shift
2.14 ± 1.96 0.46 ± 0.52 .015
Total Pages/Shift 6.14 ± 2.45 3.69 ± 1.93 .024
Total Pages/Pt/Shift 0.68 ± 0.28 0.38 ± 0.21 .007
Conclusions
Streamlined Nighttime Paging System ― NNAPPS:
Reduced non-urgent pages to residents
Reduced pt care interruptions
Increased non-interrupted resident sleep
Conclusions
Streamlined Nighttime Paging System ― NNAPPS:
Beneficial to resident education (improvement of sleep patterns)
Maintains quality & safety of pt care
Transferability
Sustainability
Thank You