Getting on the Same Page: A Quality Improvement Project to Enhance Nurse-to-Resident Communications and Reduce Overnight Sleep Interruptions

Journal of Graduate Medical Education, 2022 · DOI: http://dx.doi.org/10.4300/JGME-D-21-00846.1 · Published: June 1, 2022

Healthcare Education

Simple Explanation

Residency programs often use "home call" residents who handle hospital communications and orders from home, potentially leading to sleep disruption and fatigue. This study aimed to reduce non-urgent overnight pages from nurses to home call physical medicine and rehabilitation (PM&R) residents through a novel program. The program involved meetings between nurses and physicians to improve communication and establish guidelines for urgent and non-urgent pages.

Study Duration

17 Months

Participants

Six postgraduate year 2 PM&R residents and nurses

Evidence Level

Quality Improvement Study

Key Findings

1
The interventions resulted in a stable 25% decrease in nighttime non-urgent pages.
2
The most common hour to be paged shifted from 11 PM to 8 PM.
3
Pain, constipation, insomnia, and nausea were the most common complaints overnight.

Research Summary

This study demonstrates the feasibility of investigating text-based page logs to change the overnight paging culture of an inpatient unit. Two sets of nurse-physician meetings (less than 10 minutes each) guided interventions, improved communication timing, and had lasting effects for 13 months. The findings highlight the importance of interdisciplinary communication to improve paging culture overnight and the feasibility of implementing QI processes with text-based paging systems.

Practical Implications

Improved Resident Well-being

Reducing non-urgent overnight pages can decrease sleep disruption and fatigue in resident physicians.

Enhanced Nurse-Physician Communication

Structured meetings and clear guidelines can foster better understanding and collaboration between nurses and physicians.

Optimized Patient Care

Addressing common overnight complaints and improving communication timing can lead to more timely and effective patient care.

Study Limitations

1
The setting of our study was a rehabilitation medicine unit connected to an acute care hospital with an in-house internal medicine team for emergencies, which may limit the generalizability of our exact methods to other hospital-based less centralized units.
2
One challenge was consistent FYI sheet use.
3
An impending facility move also resulted in a nearly complete turnover of night nursing staff before intervention 2 and a high percentage of ‘‘ﬂoat’’ nurses from other units who were unfamiliar with our project.

Your Feedback

Was this summary helpful?

Back to Healthcare