Pager Fatigue: Combating Resident Burnout
Dr. Tracey Isidro, Dr. Maya Newman, Dr. Ka Hoi Hui, Dr. Patrick Mollett, Dr. Alex Wu, Dr. Bei Zhang, Dr. Jay Karri, Dr. Monica Verduzco-Gutierrez
Baylor College of Medicine
Physician burnout is significantly increasing. In a study of 3680 physicians surveyed, 54.4% reported at least one symptom of burnout. Recently, physical medicine and rehabilitation (PM&R) was ranked as the third highest specialty reporting burnout. Symptoms of burnout include emotional exhaustion, depersonalization, and a sense of reduced personal accomplishment. Physicians affected by burnout impact both individual wellness and can lead to medical errors. In one study, 75% of residents reported symptoms of burnout due to stressors like frequent interruptions by nursing staff, telephone/pagers, and fellow physicians. In two studies, residents were paged between 22.4 to 84 times daily. Generally, a small proportion of pages require urgent attention; therefore, non-urgent pages are an inherent source of inefficiency that lead to unresolved stress. Hence, the aim of our project was to see if small adjustments in systemic education could reduce non-emergent pages overnight by 50% in an attempt to decrease burnout among PM&R residents.
This is a prospective study. A pre-intervention survey determined that pages on EKG results, non-critical labs results, information to pass on to day team, and to change respiratory therapy (RT) orders were the most common non-emergent pages, and the basis to implement our intervention. We instructed on-call residents to schedule EKGs for the mornings and to instruct RTs to address issues with primary teams instead of the on-call resident. The number of non-emergent pages were recorded daily.
Post intervention, the number of pages related to EKG results decreased from 28 to 10 (64% total decrease; 46.4% decrease in daily pages), non-critical labs decreased from 21 to 8 (62% total decrease; 68.6% decrease in daily pages), information to pass onto day team increased from 17 to 27 (59% total increase; 1.9% increase in daily pages), and respiratory therapy decreased from 16 to 6 (63% total decrease; 85.7% decrease in daily pages). There was a 57.5% decrease in the number of total pages and average number of pages per night (pre-intervention: 120 total with an average of 2.35 pages a night vs. post-intervention: 51 total with an average of 1.50 pages a night.)
We decreased the total number of non-urgent/non-emergent pages for on-call residents by at least 50%. We believe that these interventions have the potential to increase workflow efficiency, help address pager fatigue, and ultimately, decrease resident burnout.