Battle of the bleep

By Jo Garland, Clinical Director, Infinity Health

Bleeps (otherwise known as pagers) are an institution in the NHS. They have been in use for decades and regularly feature in both urgent and non-urgent hospital situations. Whilst the wider world moved on from pagers and bleeps in the late 1990s, the NHS still uses 10% of the approximately 1.3m pagers left in the world, at an annual cost of £6.6m. 

There are some good reasons why the UK’s healthcare system continues to rely on old technology. It is reliable and resilient - bleeps work everywhere around a hospital because they don’t rely on wifi or mobile connectivity and the batteries last for months. They are fairly indestructible and they are a focussed form of communication, used for just one purpose - alerting clinical staff.

Bleeps are inefficient and unsafe

At the same time, these very characteristics can also cause increased risk. The simplicity of bleeps means they cannot convey enough information to allow clinicians to act. Hospital staff always need to call the initiator to get more detail including who the patient is; where they are; what is wrong with them; and how urgent the situation is. That takes time, relies on the initiator being available, and on there being a working phone nearby. They also cannot convey levels of urgency so every bleep - whether it’s a critical patient issue, or a colleague going off shift keen to share notes before they do, must receive the same response. 

If a member of staff receives a bleep in the middle of treating a patient they have to investigate, which can create risk for the patient being treated, and for the situation connected to the bleep.

The reality for doctors

Recent research published in the Journal of General Internal Medicine and Clinical Innovations shows the reality of what this means for people on shifts in a busy hospital:

• Junior doctors reported that 39% of their bleeps went completely unanswered. For SHOs and consultants that number rises to 55% and 58% respectively

• When they are bleeped and call to gather more information, junior doctors reported that the phone number they have been asked to call is engaged 39% of the time, for SHOs it is 55% of the time and consultants 47% of the time.    

This suggests that whilst the simplicity of bleeps is a draw for hospital management, it is a challenge for hospital staff. 

Addressing the problem

The same research showed that a significant number of hospital staff, both newly qualified and established, fallback on unsanctioned instant messaging applications to counter the problems of bleeps. Newly qualified clinicians use them 87% of the time for internal communication; SHOs use them 73% of the time; consultants 58% of the time. 

On the face of it this is an elegant solution, but in fact it is both dangerous and problematic. Instant messaging applications are not part of hospital technology systems so they are not integrated into the existing technical infrastructure, not covered by hospital security policies, and not supported by a Trust’s IT or digital team. Clinical staff either have to compromise patient confidentiality by sharing detailed information about them over unapproved technologies, or maintaining it by limiting those details, potentially compromising their safety. 

Bleeps are outdated but they are established and supported. Instant messaging presents risks but works so well, a large proportion of staff already rely on it. Replacing non-emergency bleeps is an important part of progressive healthcare in the UK but it needs to be with something that does the best of both worlds. 

Task management systems like Infinity, provide an option that should be considered to replace non-emergency bleeps. A task can be allocated to the right person, containing all the information in one place, with the speed of an integrated technology, and the safety and security of a hospital-supported system. The list of tasks can then easily be prioritised and the whole team has visibility of everyone’s activity in real time allowing redirection of staff or tasks when required. The reduction in interruption reduces stress for junior doctors and enables them to concentrate on care for patients and make safe decisions.