Patient characteristics and critical care workflow affect paging frequency in neurocritical care

Abstract

Indicator of response urgency (page tag), paging domains, distribution of pages by time of the day, and factors associated with neurocritical care paging remain elusive and were examined in this study. We examined the association between patient, neurocritical care workflow characteristics, and paging domains on frequency of paging using Student's t-test, Chi-square test, and analysis of covariance. A total of 1852 patients generated 36,472 pages. The most common page tagging was "for your information" (n = 15067, 41.3%), while 2.8% (n = 1006) pages were tagged urgent. Paging was most frequent for cardiovascular (12.2%), pain, agitation, distress (6.9%) and sodium (5.3%) concerns. Paging frequency was highest for mechanically ventilated patients (p < 0.001), those with indwelling intracranial pressure monitor (p < 0.04), arterial catheter (p < 0.001), central venous access catheter (p < 0.001), and in those with lower Glasgow Coma Score (p < 0.001). Patients admitted between 18:00-06:00 (aOR 1.47, 95% CI 1.16-1.86) and 14:30-18:00 (aOR 1.46, 95% CI 1.14-1.86), and sodium (aOR 1.52, 95% CI 1.39-1.66), and cardiovascular concerns (aOR 1.24, 95% CI 1.15-1.32) were associated with higher night time paging frequency. Incorporating paging domains in daily workflow and their impact on outcome of paging on escalation of clinical care and patient outcomes warrants further examination.

Keywords: Communication; Domains; Intensive care unit; Neurocritical care; Nursing; Paging; Physicians; Workflow.