The authors investigated if a wireless system of call handling and task management for out of hours care could replace a standard pager-based system and improve markers of efficiency, patient safety and staff satisfaction.
Prospective assessment using both quantitative and qualitative methods, including interviews with staff, a standard satisfaction questionnaire, independent observation, data extraction from work logs and incident reporting systems and analysis of hospital committee reports.
A large teaching hospital in the UK.
Hospital at night co-ordinators, clinical support workers and junior doctors handling approximately 10 000 tasks requested out of hours per month.
Length of hospital stay, incidents reported, co-ordinator call logging activity, user satisfaction questionnaire, staff interviews.
Users were more satisfied with the new system (satisfaction score 62/90 vs 82/90, p=0.0080). With the new system over 70 h/week of co-ordinator time was released, and there were fewer untoward incidents related to handover and medical response (OR=0.30, p=0.02). Broad clinical measures (cardiac arrest calls for peri-arrest situations and length of hospital stay) improved significantly in the areas covered by the new system.
The introduction of call handling software and mobile technology over a medical-grade wireless network improved staff satisfaction with the Hospital at Night system. Improvements in efficiency and information flow have been accompanied by a reduction in untoward incidents, length of stay and peri-arrest calls.
Can an out of hours wireless task requesting and tracking system improve quality and safety in secondary care?
The widely adopted Hospital at Night system for out of hours working is inefficient and risks introducing error. We introduced a wireless task requesting and tracking system and showed this change was acceptable and improved qualitative and quantitative markers of efficiency and safety.
Strengths and limitations of this study
The study showed clinically meaningful and statistically significant positive changes using a variety of complementary assessments. The study was observational and within a single acute NHS Trust.