Page Contents
OVERVIEW
Sending and receiving pages is quite a unique experience for new interns/residents. Typically no one will have experience using pagers simply because in most professions this technology is very obsolete. That being said, the usage of pagers within the medical field is a reality and is prone to misuse simply as a result of providers not being familiar with them. This is where this guide comes into play. It is designed to try and explain how to use pagers properly especially for those who have never had the pleasure of using pagers before.
This page includes tutorial videos in some of its sections (that demonstrates how to perform these features on the UCSF EPIC EMR system). All of these videos can be found in this folder here.
*While the preview feature for these videos may not work on certain mobile browsers, the videos can still be viewed if they are given time to load/the page is refreshed.
HOW DO I EVEN PAGE SOMEONE?
This is actually a great question. There are two major ways to page someones pager.
- Using a computer/web based text interface (preferred method if available): there are many versions of these interfaces (some are web based, others are integrated into the EMR, etc). however the base principle is the same. There is a section to include the text of your message so that you can send a text message to the pager.
- Calling the pager number on the phone (last resort if text messages are not possible): every pager should have this feature, however you can only leave a numerical message with this method (called number paging where only a callback number is given). Essentially you will call the number of the pager and then can type in your numerical message form your keypad.
The video below shows how to send text pages on two of the interphases used at UCSF (one called pagerbox, the other called American messaging):
Click here to see a video on an example of how to send text pages
*Make sure you take the time to learn how to text page in your specific care setting so you will not be responsible for sending only number pages.
WHY IS NUMBER PAGING SOMETHING THAT SHOULD BE AVOIDED?
Not everyone appreciates the issues that frequent number paging causes however its dangers are actually quite simple and are outlined below:
- Inability to triage: number pages should only be reserved for emergent situations where there is not time to send a full text message. If all messages are sent as number pages the recipient will have no idea which page to respond to first and how to prioritize urgent from non urgent pages. Pages rarely are received in isolation so it is not often physically possible for the recipient to respond to all of them all of the time. IT SIMPLY IS NOT A SAFE PRACTICE TO NUMBER PAGE UNLESS IT IS TRULY AN EMERGENCY.
- Some pages don’t require a callback: many pages that are sent actually do not require a call back and in certain cases the person holding the pagers will not be in a position to respond to each page and also deliver a high quality of care (while also actually addressing the content matter of the pages in question).
- Number pages are difficult to keep track of: imagine having the five pagers shown in the image above. If each of those pagers received nothing but number pages (a reality in some care settings) it would be incredibly challenging to keep track of all the pages that have been received as well as the pages that have been addressed/answered.
- Number pages delay the delivery of care: not only for the reasons listed above, however the recipient may be able to actually make progress on the content of the page if they have this information BEFORE they call back the page (i.e. looking through the chart of a new consult patient).
*** THE BOTTOM LINE IS THAT UNLESS IT IS AN EMERGENCY IT IS NOT ONLY POOR ETIQUETTE BUT POTENTIALLY DANGEROUS TO NUMBER PAGE UNLESS IT IS A TRUE EMERGENCY/URGEN SITUATION ***
HOW DO I FIND OUT WHO TO PAGE?
Deciding which person to page will depend partially on who you are trying to getting into contact with and what you are paging about. Sometimes it can be unclear however the following advice can be useful when trying to figure out who you should be paging.
- Always refer to institutional resources: many clinical settings will have a paging directory or some type of collection of numbers of commonly used pager numbers. Always be sure to reference these.
- For treatment teams look in the chart: this is especially true for primary teams (however sometimes consulting services will be listed in the chart as well). Most EMR systems have a system for designating who the primary team is and listing their contact information. It becomes a matter of knowing where to look in the patient’s chart to find this information.
- Learn the subtle differences between teams: often times there may be similar sounding services that actually cover separate patient populations and it is imperative that you page the correct team (an example can be two different general surgery services, one who covers elective procedures the other acute surgery). Often times paging one team is not equivalent to the other so make sure that as you can you learn the differences between services.
- Avoid paging personal pagers: this is an INCREDIBLY IMPORTANT point that is essential to practicing proper paging etiquette. While it can be tempting to directly page a provider (such as the last resident to leave a note on your patient from a consulting service) you must AVOID DOING THIS UNLESS ABSOLUTELY NECESSARY. In most instances there will be a service pager that will always be covered by the appropriate provider, however when you send a direct page to a provider you have no idea if they are still on service or if they are still even on shift or on call. A provider’s work schedule is incredibly unpredictable and direct pages to personal pagers when a covering service pager exists is generally considered to be inappropriate.
The video below shows how to find treatment teams/primary teams in the Epic EMR (which is utilized at the UCSF medical center)
WHAT FORMAT SHOULD MY PAGES BE IN?
Now that it is established that text pages are how the majority of our pages should be sent, we must discuss the proper way to send a text page. There is of course etiquette here as well as text pages should:
- Be brief and to the point (generally less then 200 characters, longer messages can be sent in multiple pages which is unnecessary).
- Include all relevant patient information (don’t forget name and MRN!)
- Utilize commonly used acronyms (like CHF) but spell out more less well known acronyms.
- Include multiple methods of contacting the person who sent the page, typically 2 phone numbers and a pager for call back (providing only a pager number is a big error to make and will result in a game of paging tag).
Here is a classic example:
Format: Your name w/ your service. Re PATIENT NAME (MRN): age/sex + one-liner, specific question. landline callback (extension), pager number, cell number.
Example: Jon w/ surg onc. Re pt. King (20899547) 69M w CHF s/p lap chole now with new onset Afib. Consult for volume mgmt. x38145, pag 7035 c245-543-8772
WHAT SHOULD YOU DO IF NO ONE RESPONDS TO YOUR PAGE?
Now invariably a situation will occur when someone does not respond to your page. This can be frustrating and challenging so the following approach is recommended.
- Put yourself in the shoes of the person you are paging: to begin with make sure you check your frustrations and take a moment to understand who you are paging and what their obstacles might be in getting back to your page. Are you paging someone who is in the OR or someone who may be indisposed?
- Make sure you contextualize the relative importance of your request: every team believes that their requests are the most important however this simply is not the case. Every recipient of your pages will have to prioritize their limited time and it is important for you to make sure you understand objectively how important your page should be to the person who you are paging. If you are sending a page that does not really need a response don’t fret. If on the other hand you are asking for help with an unstable or critically ill patient you will have to start thinking about reaching out promptly again.
- Make sure you have given enough time: it takes time to read and respond to pages (if you have used a pager before you should understand this). Make sure you have given at least 30 minutes (if it is a non-urgent request) to allow for the recipient of your page time to process your request.
- Page again: if you have reviewed the above three steps, and have not received a response in an appropriate timeframe, it is time to page again. There are different opinions, however when it comes to the second page it seems most pertinent to send a repeat page with the same text from your previous page. If it seems your second page is also not getting a response this may be one of the few instances in which sending a number page (only your callback number) is appropriate.
HOW TO SAVE TIME WHEN DRAFTING TEXT PAGES
Sometimes people will argue that text pages take too long to write and use this to justify their utilization of number pages. This generally is not an acceptable line of reasoning. There are ways to expedite your crafting of text paging and they involve using smart phrases (please review the section outlining smartphrases if needed). It can actually be quite simple to create a smart phrase that will draft your page (pulling in patient data as well) so you can easily send properly formatted text pages. Remember the better your text page the faster you will typically get not only a response to your page but also resolution regarding the content of you page.
Here is an example of an Epic smart phrase that can be used to generate pages (it will pull in patient name, MRN, age, and sex)
@ME@ from ***. Re pt. @NAME@ (@MRN@) @AGE@ @SEX@ *** x*** pag*** c***
The video below shows how to create and use a smart phrase for drafting pages (demonstrated in the EPIC EMR used at UCSF)
Click here to watch a tutorial on how to create a smart phrase that will draft your pages for you
Page Updated: 06.24.2019