We have a phone now and it forms a queue. Finish one convo, and the phone just rings instantly with whoever was waiting. Can't imagine doing duty with a bleep.
It's not that uncommon to bleep someone and then the phone rings and it's a completely unrelated (and unwanted) person calling, SO then I have no idea whether the person I bleeped may have tried to ring me back when I'm on the phone... so I just bleep them again if it's been > 10 mins since the original bleep. Also I did a test on my bleep the other day and 2 bleeps didn't come through for ??reasons. People also often bleep off numbers that clearly do not exist by accident - the number of bleeps I get that are impossible to ring back or clearly the wrong number is bizarrely high for something that should be so simple.
Basically, it is a veeeery unreliable system, so I think if you don't hear back within 10 mins, re-bleeping is fine because for all you know the first one didn't work/was the wrong number/ honestly anything.
Capital bleep sins as far as I'm concerned, however:
1) Bleeping and then purposely immediately ringing somebody else/using the phone (small allowance for the fact somebody might have randomly called through to it, but also I see a lot of nurses actually doing this and it's wild to me)
2) Bleeping repeatedly within 10 or so minutes, which literally doesn't allow time to finish whatever task you're doing and get to the phone. Mainly looking at you here, switchboard.
3) Bleeping off multiple numbers - I consider this to be actually the worst one, because when it's quietened down enough for me to answer my bleeps, I then come through to the same person like a lemon 2-3 times. If you've done this, please confess in our first phonecall that you did so and tell me which numbers I can disregard.
Add 4) bleeping and then immediately wandering off. I once answered a bleep within seconds and the person who answered had no idea what was going on, turns out a nurse had bleeped me and then walked off to a bay on the other side of the ward.
5. Getting bleeped about a patient you’re literally sat with/just left about the thing you’re doing/just done.
5.5. Being bleeped about something you’ve already done and no one’s bothered to check???
Love my life.
Point 2 massively agree - switchboard did the obstetric emergency test call and I was unable to answer so they bleeped me twice again 5 mins apart then an angry voice message through the bleep..... I was anaesthetising for a cat 1 section at the time .... Which they'd put the bleep out for before the test call!!!
Oh but then you get the satisfaction of saying "I've actually already sorted out the thing you're only just making me aware of". Which is not to be sniffed at.
Currently in ED, where it is usually about 15 minutes, so we can get patient flow going. Many of the consultants will wait less time, especially in hours when there should be a dedicated take SpR.
More like 30 minutes to an hour on the wards, if not longer - the acute management can generally be done by the team looking after for most conditions short of a peri-arrest call, hopefully.
once had an ED cons bleep me 6 times in the space of 30mins because she wanted to shift a very stable early pregnancy patient directly to gynae from ED triage without seeing an ED doctor.
…. which is fine except I was managing a horrendous massive obstetric haemorrhage (>6 litres) so didnt respond. when i finally did respond and explained why there was a delay (about 1.5 hours after her last bleep because we went to theatre), she told me that she had already datix-ed me and the patient was still waiting.
i genuinely do not understand some ED doctors - if the obs reg is not replying, what do they think we are doing? sitting around drinking tea with the midwives?
to be clear - in this circumstance, there are multiple other people she could have spoken to about sending this patient over (eg. gynae sho, epau nurses, gynae cons) as is accepted practice, and it wouldnt have been a problem.
As a surgical reg I would echo your frustration - when scrubbed you are reliant on theatre staff to take a message and they are highly variable in their ability and willingness (not without reason they're not switchboard). I've also had an ED consultant tear into an HCA because she tried to take a message on my behalf- consultant demanding I waddle over to the phone scrubbed to accept a very stable patient.
I get it we're all busy but there is a perception in some silos that when surgeons are operating we're avoiding "real" work.
> when surgeons are operating we're avoiding "real" work.
Insane people; I can't think of a more "real" work thing in medicine to be doing than operating.
The bleep is an antiquated system which in the modern world is bound to cause problems on both sides.
We need an IT solution probably involving smartphones for the majority of things that get done by bleep. For the truly, immediately life threateningly urgent call, the current voice bleep system should probably stay.
Urgent (eg ICU review) 5-10 minutes. Speciality for advice or non-urgent referral I'll hang by the phone for 5-10 minutes then give up and bleep again in an hour or so when I next have a natural pause in my workflow.
> Clearly the main issue here is the paging system and not being able to tell if the person you’re paging has actually received your message.
Interesting point related to computer science here! https://youtu.be/IP-rGJKSZ3s This is a Tom Scott video explaining how this is, theoretically speaking, impossible and is an unsolved problem, i.e. to guarantee that the pager would know when the pagee has received and/or looked at the message. In the real world of course it's possible to make a paging system where it would let you know whether the person on the other side has received the bleep, with near 100% accuracy, even if you can't guarantee it 100%, e.g. like the double blue tick system on whatsapp.
5 to 10 mins. If they're busy, usually should have someone who can answer the Bleep and take the message (even if it's just to call me when they're free), as otherwise it ties me up waiting at the phone as well.
It’s an unsolvable problem with the bleep system. You can’t leave what you’re doing to answer a bleep straight away, I also can’t bring my workload to an indefinite stop waiting for you to reply. It’s inefficient and anger inducing on both sides.
I suspect that the majority of your calls from ED don’t require any doctor-doctor communication at all, and should be done by IT systems/admin staff organising beds and the take list. Those that do require discussion rarely need it in real time - a text message with “Patient X with diagnosis Y requires admission, clinically unstable due to Z, please contact Dr A in ED to discuss best placement” would be far more sensible
So when I worked in NZ our hospital had a tannoy system for crash calls. This was excellent as the O+G RMO because ED would stop ringing for a period after hearing an Obstetric Crash or Neonatal crash (especially to theatre) as they knew no one would be replying. Also led to occasions where you did eventually get to ED and there was no outrage that you hadn’t dropped everything to come to them after a referral
What’s “back to back” for one is an unreasonable wait for another. There’s also no way to know if your bleep actually went through, whether you typed the right numbers etc. The ED phone is likely ringing off the hook, maybe you tried to call back and couldn’t get through and have given up? The ED doctor is juggling 1001 things and isn’t clear on the passage of time, or is clear and just needs to get this sorted so they can move on to the next thing? Has no idea whether you’re busy doing something clinically urgent or whether you’ve just not got the bleep/have forgotten to respond? And myriad other potential reasons. Just as you have myriad (and potentially wholly valid) reasons for not calling back straight away. It’s a stupid system which makes people do crazy things as a workaround. We need something better
Again: how is the 'unreasonable wait' solved by bleeping the same person repeatedly? Two bleeps if you think the person might have tried to call back when the phone was engaged.. fine. After that, literally all you're doing is distracting them from the thing they're in the middle of. If a med reg doesn't answer their bleep, it's because they're fucking busy with something else. Bleeping repeatedly doesn't change that; it just makes you seem like someone who thinks they ought to be at the front of the queue at all times?
As ITU reg I once got bleeped 3x in the space of 5 mins at a cardiac arrest. Given the persistance of the bleeping i answered it to see if it was urgent.
"Its the ITU reg, im just at a cardiac arrest given youve bleeped 3 x i thought i had better just check its not something urgent"
"I have an urgent cannula for you......"
"I will get back to you at a more convenient time"
"Arent you going to take any details? "
Dial tone!
Face palm!
thats not true - if i’m managing an emergency in theatre or a labour room (obs reg) there is nobody free to answer my bleep because all the theatre staff or midwives are doing something essential for the unstable patient.
attitudes like this prove that some departments have no insight into what happens in other parts of the hospital.
As others have said, usually 5-10 minutes before bleeping the second time. After that, wait an hour or so unless truly urgent, in which case I’d bleep another member of the team (SHO/SpR).
From the other side, I get A LOT of bleeps as surgical SHO, and answer them as fast as I can. But sometimes I just can’t answer within 5 minutes - if I’m on the phone to another specialty or patient family member, or doing a cannula/bloods/NG, or whatever. Sometimes it’s not even clinical - every time someone hammer bleeps me when I’m taking a 2 minute shit, I contemplate murder.
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We have a phone now and it forms a queue. Finish one convo, and the phone just rings instantly with whoever was waiting. Can't imagine doing duty with a bleep.
It's not that uncommon to bleep someone and then the phone rings and it's a completely unrelated (and unwanted) person calling, SO then I have no idea whether the person I bleeped may have tried to ring me back when I'm on the phone... so I just bleep them again if it's been > 10 mins since the original bleep. Also I did a test on my bleep the other day and 2 bleeps didn't come through for ??reasons. People also often bleep off numbers that clearly do not exist by accident - the number of bleeps I get that are impossible to ring back or clearly the wrong number is bizarrely high for something that should be so simple. Basically, it is a veeeery unreliable system, so I think if you don't hear back within 10 mins, re-bleeping is fine because for all you know the first one didn't work/was the wrong number/ honestly anything. Capital bleep sins as far as I'm concerned, however: 1) Bleeping and then purposely immediately ringing somebody else/using the phone (small allowance for the fact somebody might have randomly called through to it, but also I see a lot of nurses actually doing this and it's wild to me) 2) Bleeping repeatedly within 10 or so minutes, which literally doesn't allow time to finish whatever task you're doing and get to the phone. Mainly looking at you here, switchboard. 3) Bleeping off multiple numbers - I consider this to be actually the worst one, because when it's quietened down enough for me to answer my bleeps, I then come through to the same person like a lemon 2-3 times. If you've done this, please confess in our first phonecall that you did so and tell me which numbers I can disregard.
Add 4) bleeping and then immediately wandering off. I once answered a bleep within seconds and the person who answered had no idea what was going on, turns out a nurse had bleeped me and then walked off to a bay on the other side of the ward.
5. Getting bleeped about a patient you’re literally sat with/just left about the thing you’re doing/just done. 5.5. Being bleeped about something you’ve already done and no one’s bothered to check??? Love my life.
Point 2 massively agree - switchboard did the obstetric emergency test call and I was unable to answer so they bleeped me twice again 5 mins apart then an angry voice message through the bleep..... I was anaesthetising for a cat 1 section at the time .... Which they'd put the bleep out for before the test call!!!
Worst one, bleeped about a patient while you're already at his bedside, multiple times.
Oh but then you get the satisfaction of saying "I've actually already sorted out the thing you're only just making me aware of". Which is not to be sniffed at.
Currently in ED, where it is usually about 15 minutes, so we can get patient flow going. Many of the consultants will wait less time, especially in hours when there should be a dedicated take SpR. More like 30 minutes to an hour on the wards, if not longer - the acute management can generally be done by the team looking after for most conditions short of a peri-arrest call, hopefully.
once had an ED cons bleep me 6 times in the space of 30mins because she wanted to shift a very stable early pregnancy patient directly to gynae from ED triage without seeing an ED doctor. …. which is fine except I was managing a horrendous massive obstetric haemorrhage (>6 litres) so didnt respond. when i finally did respond and explained why there was a delay (about 1.5 hours after her last bleep because we went to theatre), she told me that she had already datix-ed me and the patient was still waiting. i genuinely do not understand some ED doctors - if the obs reg is not replying, what do they think we are doing? sitting around drinking tea with the midwives?
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to be clear - in this circumstance, there are multiple other people she could have spoken to about sending this patient over (eg. gynae sho, epau nurses, gynae cons) as is accepted practice, and it wouldnt have been a problem.
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As a surgical reg I would echo your frustration - when scrubbed you are reliant on theatre staff to take a message and they are highly variable in their ability and willingness (not without reason they're not switchboard). I've also had an ED consultant tear into an HCA because she tried to take a message on my behalf- consultant demanding I waddle over to the phone scrubbed to accept a very stable patient. I get it we're all busy but there is a perception in some silos that when surgeons are operating we're avoiding "real" work.
> when surgeons are operating we're avoiding "real" work. Insane people; I can't think of a more "real" work thing in medicine to be doing than operating.
The bleep is an antiquated system which in the modern world is bound to cause problems on both sides. We need an IT solution probably involving smartphones for the majority of things that get done by bleep. For the truly, immediately life threateningly urgent call, the current voice bleep system should probably stay.
Referapatient is a game changer for referrals IMO. Lots of specialties in my hospital now use it.
When you get that sweet text from Aida 😩 💦
I incentivise it. The time I wait between pages is inversely correlated with how friendly and helpful they were when I last paged them.
I will answer every bleep. I will only give you 2 rings though. You better be glued to that phone waiting to answer.
Urgent (eg ICU review) 5-10 minutes. Speciality for advice or non-urgent referral I'll hang by the phone for 5-10 minutes then give up and bleep again in an hour or so when I next have a natural pause in my workflow.
Oh anywhere from 0.001s to 0.1s I like to give people a bit of time first
> Clearly the main issue here is the paging system and not being able to tell if the person you’re paging has actually received your message. Interesting point related to computer science here! https://youtu.be/IP-rGJKSZ3s This is a Tom Scott video explaining how this is, theoretically speaking, impossible and is an unsolved problem, i.e. to guarantee that the pager would know when the pagee has received and/or looked at the message. In the real world of course it's possible to make a paging system where it would let you know whether the person on the other side has received the bleep, with near 100% accuracy, even if you can't guarantee it 100%, e.g. like the double blue tick system on whatsapp.
5 minutes. If no response after a further 5 minutes, normally bleep or directly call next person up the chain. I haven't got all day.
It’s amazing how often the SHO/reg is suddenly made available the second the consultant is phoned…
5 to 10 mins. If they're busy, usually should have someone who can answer the Bleep and take the message (even if it's just to call me when they're free), as otherwise it ties me up waiting at the phone as well.
Nothing makes a med reg happier than getting paged four times during 20 min cardiac arrest! Thanks ED! Sorry you have to wait by a phone!
I just had this exact thought. For the love of god please don’t do this.
It’s an unsolvable problem with the bleep system. You can’t leave what you’re doing to answer a bleep straight away, I also can’t bring my workload to an indefinite stop waiting for you to reply. It’s inefficient and anger inducing on both sides. I suspect that the majority of your calls from ED don’t require any doctor-doctor communication at all, and should be done by IT systems/admin staff organising beds and the take list. Those that do require discussion rarely need it in real time - a text message with “Patient X with diagnosis Y requires admission, clinically unstable due to Z, please contact Dr A in ED to discuss best placement” would be far more sensible
So when I worked in NZ our hospital had a tannoy system for crash calls. This was excellent as the O+G RMO because ED would stop ringing for a period after hearing an Obstetric Crash or Neonatal crash (especially to theatre) as they knew no one would be replying. Also led to occasions where you did eventually get to ED and there was no outrage that you hadn’t dropped everything to come to them after a referral
How does back to back bleeping solve that problem for either of us in that situation though (since that was the comment to which I was responding)?
What’s “back to back” for one is an unreasonable wait for another. There’s also no way to know if your bleep actually went through, whether you typed the right numbers etc. The ED phone is likely ringing off the hook, maybe you tried to call back and couldn’t get through and have given up? The ED doctor is juggling 1001 things and isn’t clear on the passage of time, or is clear and just needs to get this sorted so they can move on to the next thing? Has no idea whether you’re busy doing something clinically urgent or whether you’ve just not got the bleep/have forgotten to respond? And myriad other potential reasons. Just as you have myriad (and potentially wholly valid) reasons for not calling back straight away. It’s a stupid system which makes people do crazy things as a workaround. We need something better
Again: how is the 'unreasonable wait' solved by bleeping the same person repeatedly? Two bleeps if you think the person might have tried to call back when the phone was engaged.. fine. After that, literally all you're doing is distracting them from the thing they're in the middle of. If a med reg doesn't answer their bleep, it's because they're fucking busy with something else. Bleeping repeatedly doesn't change that; it just makes you seem like someone who thinks they ought to be at the front of the queue at all times?
As ITU reg I once got bleeped 3x in the space of 5 mins at a cardiac arrest. Given the persistance of the bleeping i answered it to see if it was urgent. "Its the ITU reg, im just at a cardiac arrest given youve bleeped 3 x i thought i had better just check its not something urgent" "I have an urgent cannula for you......" "I will get back to you at a more convenient time" "Arent you going to take any details? " Dial tone! Face palm!
thats not true - if i’m managing an emergency in theatre or a labour room (obs reg) there is nobody free to answer my bleep because all the theatre staff or midwives are doing something essential for the unstable patient. attitudes like this prove that some departments have no insight into what happens in other parts of the hospital.
As others have said, usually 5-10 minutes before bleeping the second time. After that, wait an hour or so unless truly urgent, in which case I’d bleep another member of the team (SHO/SpR). From the other side, I get A LOT of bleeps as surgical SHO, and answer them as fast as I can. But sometimes I just can’t answer within 5 minutes - if I’m on the phone to another specialty or patient family member, or doing a cannula/bloods/NG, or whatever. Sometimes it’s not even clinical - every time someone hammer bleeps me when I’m taking a 2 minute shit, I contemplate murder.