The Neurosurgical Registrar – are we still as busy as we were? A Quality Improvement Study

Bleeps represent an important element of the on-call neurosurgical registrar’s workday. They provide instant contact between healthcare staff, while allowing doctors to perform tasks across the hospital. However the paging system causes interruptions and can interfere with patient care. We aim to develop and implement strategies to improve paging patterns and ultimately reduce unnecessary calls. we conducted a retrospective analysis of electronic hospital bleep records over a 7-months period (March-September-2015) in which bleep logs were retrieved from the hospital paging system at University Hospital of Wales. The first cycle was followed by a set of interventions followed by a second data-collection cycle 12 months later. The first cycle showed that on average the neurosurgical registrar received 57 bleeps per 24hrs. Almost a third of on-call bleeps were new referrals received from the local accident & emergency department or from other district hospitals. Other calls were received from our own hospital’s wards and Intensive Therapeutic Unit (10%), the paediatric ward (5%), neurosurgical theatres (5%) and emergency theatre (5%). The second cycle showed a 23% drop in the total number of bleeps compared to first cycle. The difference in bleep numbers was evident during the day shift, and no difference was noted during the night shift. No difference in the number of new referrals was noted. This project has shown that a simple change can result in a significant improvement. It also confirmed the value of team work and communication in improving quality of care.