Intended for healthcare professionals

Feature Hospital Technology

Slow death of the bleep: why hospital pagers won’t die

BMJ 2021; 372 doi: https://doi.org/10.1136/bmj.n684 (Published 31 March 2021) Cite this as: BMJ 2021;372:n684
  1. Jo Best, freelance writer
  1. London, UK
  1. jo.best{at}journalist.com

Despite promises that pagers would be gone by the end of 2021, hospitals look set to retain them for critical situations at least, Jo Best reports

Pagers have been a staple of hospital communications for decades, but in 2019 the English health and social care secretary, Matt Hancock, announced that NHS trusts would phase out bleeps for non-emergency communications by the end of 2021.1 Soon after, the Conservative MP Alan Mak introduced a bill in parliament to end the use of fax machines and pagers in the NHS,2 saying the devices have “many limitations,” and “there is now simply no good reason why pagers should still be used.”

Yet persist they do. The technology is over 50 years old, and a report based on freedom of information requests to NHS trusts in 2017 estimated that around 130 000 pagers were still in use, at a cost of £6.6m (€8m; $9m) a year.3

But pagers usually offer only one-to-one messaging for basic tasks such as relaying the sender’s number for the recipient to call back. Typically, they can’t convey the name of the contact, the nature of the request, or the urgency. Because staff bleep numbers may not be held in a central directory or may change, it’s not always easy for clinicians to contact the person they need when they need them.

We now have smartphones

“Pagers are a slightly obsolete technology. The world has moved on,” says Bola Rotibi, research director at the technology analysts CCS Insight. Healthcare practitioners now have smartphones and need communication tools that are “much more capable of doing richer, contextual, and relevant communication. The environment that pagers were designed for no longer exists, partly because we have all become more connected and more mobile, in every sense of the word.”

Pagers run on a separate network to mobile phones and wi-fi, using local transmitters that are run by third parties. No network is 100% reliable, but pagers are as close to it as it gets.

In 2017, Vodafone decided to shut down its paging business,4 leaving only one supplier that supports NHS bleeps, Capita's PageOne, and no competition that might drive down costs. As the overall market for the devices dwindles—it’s thought the NHS uses more than 1 in 10 of all pagers worldwide—the cost of replacing devices grows; a new pager cost about £400 in 2019.1

Trusts are being encouraged to replace pagers: in 2020 NHSX, which sets policy for technology, digital, and data in the NHS, launched the £3m clinical communication framework to allow trusts to procure services to replace pagers with apps that run on smartphones and tablets. Pager replacement apps offer extra functionality. Secure messaging can transmit more complex information, including images and other patient data while meeting patient safety and data protection regulations (box 1).8

Box 1

Planet of the apps

Instead of just one-to-one communication, pager replacement apps can allow clinicians to send queries and requests to groups of people, making it more likely staff will find the right person to help. Read receipts let clinicians know when their messages are received. Apps can show urgency so users know whether it’s a routine query or something more pressing. They also offer staff directories. There are 25 suppliers on the NHS framework.5

Peter Young, an anaesthetist and intensive care specialist at Queen Elizabeth Hospital, King’s Lynn, has been using the Call-4-Help app,6 created for the hospital at Young’s request by tech companies Kulestar, 4 Roads, and Concept Softworks. The app, which is being piloted in the hospital's intensive care unit, was designed to help new staff brought in to cope with the increase in patients with covid-19 quickly get answers to queries from a group of users.

The app has become a to-do list for the unit, allowing staff to put out requests for tasks to be completed that can be picked up by relevant staff members.

“Nurses can put things on it so they are not bothering the doctors with something like changing a prescription if it’s not a time critical thing,” says Young. Compared with job requests using bleeps, “where you’d try to find someone, ask them to do the job, be told ‘I haven’t got time’ or ‘I’m just finishing my shift,’ and have to find someone else, this takes no time at all,” Young adds.

For junior doctors in particular, moving from pagers to apps means fewer interruptions in their work. A 2017 pilot in West Suffolk NHS Foundation Trust, for example,7 found doctors using a pager replacement app saved 48 minutes a shift, and nurses saved 21 minutes, as it enabled tasks to be completed more efficiently and with fewer interruptions. Apps can show which staff are picking up which types of jobs and with what frequency, which can help with career development.

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Why pagers persist

The suggestion that pagers should be replaced by apps has aroused trepidation in some clinicians. Despite their limitations, pagers remain popular with many doctors: they are small and lightweight, have long battery life, and are reliable, with network connectivity rarely a problem. In general, they work as intended, and their use and functionality are fairly standard among hospitals. The same can’t always be said for the smartphone apps designed to replace them (box 1).

Vinay Badhwar, a foundation year 2 doctor in the East Midlands deanery who has worked at hospitals using both pagers and apps, acknowledges the anxiety that comes with change. “The only thing that would put doctors off a new system is something that could compromise patient safety,” he says.

“You’d never want a situation where your phone couldn’t get a signal or you miss an important call because your battery died. If there’s something that is proved, and saves time or helps patients, doctors will adapt to it. It’s important to make sure that staff are appropriately trained and there are backup systems in place.”

Despite Hancock’s aim, pagers are unlikely to disappear from wards by the end of this year. Against the background of the pandemic the Department for Health and Social Care’s (DHSC) messaging has softened from phasing out pagers to a recommendation that trusts adopt more modern communication methods, such as the services on the framework, and the department is not tracking trusts’ progress.

Keep for critical situations

The DHSC has said that pagers should be retained for emergency situations—for example, to ensure clinicians can communicate when wi-fi or mobile networks fail or other types of communication can’t be used.

Network coverage in hospital buildings may be improving, but dead zones for wi-fi or mobile signals are still common. Consumer smartphones are typically less reliable than pagers, and time critical communications such as cardiac arrest calls look likely to remain on pagers for the foreseeable future.

“A reliance on hospital wi-fi and [mobile networks] is not suitable for emergency communications in many hospitals because of coverage and reliability issues,” says Nigel Gray, director of PageOne. “A dedicated radio frequency with blanket coverage using local high power transmitters provides the best way to send emergency messages to many people at once. Paging also ensures critical alerting is maintained even during major incidents—for example, terrorist events—that can disrupt or overload public mobile networks.”

Best of both worlds

For doctors this may mean continuing to hold a pager but also using an app on their phone. Many clinicians already do: one study found about a third of doctors use consumer messaging apps such as WhatsApp to send clinical information about patients.9 Pager replacement apps offer a similar means of sharing patient information without threatening confidentiality or data protection guidelines.10

Although doctors are generally advised to avoid apps like WhatsApp for sharing patient information whenever possible because of the confidentiality risks, tolerance of their use has increased, particularly in emergency situations like the Grenfell fire11 and covid-19. NHSX says doctors can use it “where there is no practical alternative and the benefits outweigh the risks.”12

For now, a hybrid situation is the reality, says Neville Dastur, consultant vascular surgeon and cofounder of pager replacement app Hospify. “We’re there already: we have very prevalent use of WhatsApp in the medical space, and that proves that people don’t mind carrying two devices.”

“There are apps that are as simple as WhatsApp that we can use now, and they protect not just patients but doctors and healthcare professionals as well.”

Footnotes

  • Competing interests: I have read and understood BMJ policy on declaration of interests and have no relevant interests to declare.

  • Provenance and peer review: Commissioned; not externally peer reviewed.

References

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