Direct Notification Systems Outperform Live Operators

In the past several weeks I’ve been speaking with providers and practice managers frustrated by the quality of after-hours communications. Despite dissatisfaction with their current service, many providers have the impression that a live service is somehow better for patient care. I’ve been skeptical and have been looking for some objective data on this topic. I’ve just found it.

One of the few peer reviewed studies to examine the comparative effectiveness of live –vs- automated communications systems was published about ten years ago by Moss and colleagues in the Department of Medicine at Emory University (where I spent years laboring on my Ph.D.!). The article can be accessed for free here or can be downloaded as a PDF.

The overarching goal of the study was to characterize clinician response times to pages originating from the intensive care unit (ICU) at two university-affiliated hospitals. The study examined a total of 402 pages sent to 166 different physicians when the page was either a) sent directly to the provider or b) through a 3rd party intermediary such as an answering service or a physician’s office. The difference was stark, and most certainly did not support the notion that “live is better.”

Key data points include:

  • The median response time for a direct paging system was 2 minutes compared to 9 minutes for indirect systems relying on a 3rd party intermediary.
  • Slow responses (≥ 15 min) were observed in 40% of all indirect pages compared with only 8% of direct pages.
  • Twenty-five percent of the pages placed through an indirect system (e.g. answering service) were associated with a response time of ≥ 29 min.

Collectively, these data suggest that simple, automated systems are more likely to result in timely responses to patient care issues, particularly in urgent situations.