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Paging patterns of orthopaedic night float residents at two academic hospitals

Benjamin Ward, M.D.

The purpose of this study was to compare and characterize the differences between pages received by the orthopaedic night float resident at Massachusetts General Hospital (MGH) and Brigham and Women’s Hospital (BWH). A secondary purpose was to determine if a formalized resident rounding schedule would reduce the number of pages received by the night float resident at BWH. METHODS: Six different residents at both institutions recorded logs of total number of primary patients and the number of pages received per night float shift. The ratio of pages per patient was calculated to compare the two different hospitals. Additionally 4 residents recorded the message content of each page to categorize the reason for the page. Subsequently a formalized twice nightly rounding schedule was initiated and 3 months later 2 residents at both institutions recorded the same data.

Data was collected for a total of 55 weekday night shifts at each institution. The ratio of pages to patients was significantly higher at BWH compared to MGH (1.40 vs 0.73, p<0.05). The most common reason for paging at both hospitals was patient pain. After formalized rounding was initiated no significant decrease in paging frequency was observed.

The expected number of pages per patient received by the orthopaedic night float resident shows significant variation between institutions with pain being the most common reason for paging. Formalized rounding by the night float resident did not decrease the number of pages received. Decreasing the number of pages received by the night float resident would reduce fatigue, reduce work interruptions and possibly reduce medical errors.