The Doctor's viewpoint

What the bleep!

I hate my bleep. Its like carrying around an electric shock. I think everyone else hates it too.

I work in a hospital full of people, yet to find any one person is pretty impossible. Many man days have been spent trudging around radiology back corridors trying to find the person who will do the test I need because I cant bleep them.

Unfortunately the most ubiquitous method of communicating within hospitals remains the bleep system. I imagine this system reflected the evolution of a hospital from blood-letting front rooms in a philanthropic’s Dickensian house, into buildings that were too big to walk around in 10 minutes.

Consequently, to get the person you needed, radio transmitters, or bleeps were deemed more time efficient. The bleep amounts to a belt-strapped radio box that bleeps like an alarm when someone is trying to contact you. This someone triggers the bleep by finding a phone, dialling your bleep code, and then the phone they are calling from. The number they are calling from flashes up on the bleep and then the recipient finds a phone and calls that person back.

In other words A calls B which goes to C; C finds a phone and calls B. Of course many times A can't find a phone, or A calls B and the bleep goes to D. D tries to respond and when the phone isn’t engaged, he goes through to E who tells him that the phone is a fax and anyway A has left because it took too long to respond. D then calls F only to find it is engaged. Finally he resorts to calling G who shouts at him for disturbing him in the middle of a meeting. In the meantime, A has been waiting for 10 minutes, so he calls H who is in a part of the hospital where there are no phones ...

Hospitals are very dynamic places. People often have to be contacted fast for complex problems, yet the telecommunications within hospitals is terrible and often archaic. In an era when I can write this article on my phone and email it from the park, surely someone could implement a better solution than the bleep.

The mobile phone seems a sensible solution. The ingrained fear regarding causing fatalities in hospital has long since been dispelled by the Parliamentary Health Select Committee and the Medicines and Healthcare products Regulatory Authority, but the fear continues to be a cultural NHS phenomenon. Apart from causing deaths and plane crashes the various arguments such as mobiles being noisy and invading privacy are also weak considering the daily noise on a ward (especially from the ward phones themselves).

It is a matter of fact that within hospitals doctors are already using their own mobile phones. It is simply easier, less stressful and more time efficient to do so. I once carried out an unpublished study on the time efficiency of bleeps in hospital within a month which showed junior doctors waste around 45 minutes a day (excluding talk time) on receiving bleeps or creating them.

This did not take into account the time taken to resume interrupted tasks. This represents a large proportion of the day and of course work not done during the day will have to be done after hours. Naturally the switch to mobiles.

This not only costs a lot for the doctor (and can’t be reclaimed) but also means that it is unregulated, so if anything, concerns regarding patient confidentiality are compounded (although again, what is the difference for patient confidentiality between talking on a landline and talking on a mobile?). Indeed the only reason I don’t use my mobile to make work calls in hospital is because I have to pay for it and therefore pay for a failure of the system.

However, if I were to lose my bleep (God forbid) I would have to pay £200 of my own money to get another. A phone would cost me £30. Can a bleep hold clinical reference handbooks, as well as a calculator, and all the contact numbers of everyone in the hospital (which no doubt would relieve the burden on switchboard)?

The need to telecommunicate extends to patients and the argument for mobiles in hospital is particularly applicable here. The rather cynical move to provide bedside telephones on wards at a huge cost to the patient for incoming and outgoing calls does nothing to increase privacy or reduce noise. The practical issues of bedside phones for every patient are also evident.

When on a ward round I am often forced to peer through a mass of commodes, bedside cabinets, chairs, personal belongings, hoists and a bedside phone hanging from the wall and all this within the confines of the ever reducing NHS bed space. Any more equipment and there will be no room for the patient. More importantly, patients in hospital are isolated. Visiting times are restricted and the patient may need support from a relative or vice versa at different times. Social contact is essential and a part of getting better.

Other solutions exist I suppose. Porters often use walkie-talkies around the hospital (and no fatal arrhythmias have been caused by this method). A&E uses a tannoy system but everone hates it. Pigeons... smoke signals... shouting down the corridor? There aren't many alternatives.

Of course I’m sure IT departments in trusts everywhere are aware of the need for better communications. Perhaps these projects have been sidelined by more pressing projects such as Choose and Book.

From a personal perspective, poor telecommunications within hospital is a major cause of time inefficiency and stress, all of which could be solved with either a trust-wide agreement with a telecoms provider or an in-house solution (cf. Sherwood Forest Hospital with audited time savings).

The point is that the ability of trust staff to communicate efficiently is part of the systemic well-being of a hospital and can only be reflected in better and more efficient patient care.

I suppose the only joy of bleeps is when the belt buckle shriek you thought was yours, turns out to come from someone else!