I am bound to my bleep. I carry that absurd relic of technology around, dragging out of the pocket of my lightweight scrubs and it makes me a slave to one way communication.
There are different ways to be summoned by a bleep. The least urgent is just a couple of bleeps with an extension number that flashes on the screen; you might return the call in minutes. In an emergency, you are summoned with a different sort of noise and a crackly voice message telling the relevant team where to go and when: ‘Trauma alert A&E resus ten minutes’.
Then in a particularly pressing emergency, you hear a couple of fast bleeps and a voice, telling you, specifically, to go somewhere, immediately.
This is the type of call you drop something and run for.
‘Intensive care registrar to A&E resus immediately.’
I wasn’t yet finished morning handover when I got this message, but the consultant said ‘you’d better go, I’ll fill you in’ so I left and scurried down two flights of stairs, along a corridor, turned left in the foyer, down to the end of another corridor, left again, through some double doors, through the major injuries department and then arrived; to one patient, one advanced clinical practitioner and one charge nurse in the resus department.
‘Intensive care registrar,’ I said. ‘You called me?’
The advanced clinical practitioner started off the tale of the history of presenting complaint. Catching my breath, after ten seconds I stopped him; ‘can you just tell me the emergency bit and we’ll get to all that afterwards?’
‘What?’ he asked.
‘The emergency bit, that you called me for; you know, A, B, C or D?’
‘Oh, well we haven’t got intravenous access and we’ve estimated 500ml of blood loss.’
I looked at the monitor; heart rate 72 beats per minutes, mean arterial blood pressure 62, saturations 100 per cent, normal respiratory rate. I looked at the patient; awake, alert, pale lips and pressure dressing on her groin, no active bleeding.
‘Has anyone else here tried?’
‘Have you looked with the ultrasound?’
‘…and that’s what you put out the fast bleep for?’
The practitioner seemed irritated and said ‘Yes. Do you think that’s it’s inappropriate to call you?’
‘No’, I replied, ‘you’re always welcome to ask for help, but I think it was an inappropriate use of an emergency fast-bleep, but anyway, let’s leave that for later’.
The charge nurse wheeled the ultrasound into the cubicle and I placed two cannulas into the patient’s arm.
The practitioner had gone to the bench to write his notes and so I approached him and said that I was sorry, if I had seemed grumpy, but I didn’t feel that was an appropriate call. I told him that I am a registrar who will always run to an emergency if asked and that I didn’t want that to change.
The patient was still stable, so I left, still a slave to that little black boxed relic of one-way communication and knowing that because it is my job too, to care about the flock of sheep, that I would in reality, always find myself running to a boy crying wolf.
By the Secret Doctor
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As an F1 on one of my first weekend ward covers I was fast bleeped out in the middle of a conversation with the Med Reg about a sick patient I was worried about.
I ran to the ward to find a nurse who said that she wanted me to write up a stack insulin prescriptions for the next morning. She said she'd fast bleeped me because she had normal bleeped me a couple of minutes ago and I hadn't come yet. I tried to explain that I was in the middle of sorting out a deteriorating patient with the Reg and that this wasn't an emergency and she just walked away.
I was so angry at the misuse of the system but felt completely unable to do anything about it. You're right that in a one way communication system we are forced to accept the cries of "wolf" for fear of missing the real emergency.
first "bleep"experience working as a house officer in the UK in 1995, coming from the Netherlands then found the way the bleep system was working pre-historic with a call back system and no immediate direct contact with the person calling your bleep. Returning to the UK in 2017 to find that in 22 years nothing has changed.....
Allowing Nurse Practitioners to breach the chain of command has let the system degenerate into the situation described, all too often and in every hospital. Nurse Practitioners should be asked to report to their next higher healthcare professional in their chain of command and not fast bleep anyone they feel like.
Could you imagine the bollocking you would get as an foundation doctor if u fasted bleeped the ITU ref for a cannula and the patient wasn't genuinely exsaginating in front of you. I would be livid with my surgical foundations doctors if they inappropriately called another speciality like that without having called me first!
Amy junior staff member, doctor or nurse, should escalate internally to a competent practitioner before externally. The fact that this ENP asked whether it was appropriate suggests she knew it was not.
We have banned individual fast bleeps locally on the principle that if someone is so sick they need AN Other to run there, more than one person will be required and a team (crash team/MET) will be necessary.
I recall fast bleep med reg calls to patients from an HCA who proceeded to abandon me with whatever disaster has entailed with no help. Too many to count.
Oh how true, I remember it well, nothing has changed!
In 1979 I got enslaved by the bleep. At least no one knew better. Some things don't change even afte 38 years!
Perhaps it's time to turn the 'Im going to Datix that' veiled threat doctors so often get back...
That should have been a datex - inappropriate use of fast bleep. What If you were stuck with another patient who needed you more than this one in resus. Anaesthetists are not glorified cannula inserters.
I ran (leaving a deteriorating patient) for one fast-bleep as a med SHO covering hundreds of patients - only to find on arrival that it was the discharge coordinator, asking me to write a discharge summary! The simplest solution is to then show them that abuse of the system does not work - explain that they have used the communications system incorrectly (whether knowingly or not), and walk away, before or after ensuring they have called the correct response instead (depending on the situation).
Thanks for sharing. I'm still a medical student, but the idea of carrying a bleep as an F1 fills me with anxiety. From reading this and some of the other comments, I was inspired to write a poem reflecting my interpretation of your experience:
Cry wolf, and still I come,
Bleeping fast and manic;
The crackled voice, the rushed tones,
And in my mind I panic.
Still I rush down flights of stairs,
Flinging open double doors,
Thinking frantically of the sheep,
To be called for but a chore.
Annoyed I am that I was called
To tend the man un-needed,
So ask politely must I do,
That urgency must be heeded.
I offer help, and say I’ll run,
If ever you need my time,
But please, don’t cry wolf again;
You might make my temper climb.
And into the vein I place that sharp,
The tube safe and secure.
And then with grumpy shoulders slumped,
I ask if there’s any more?
Cry wolf, and still I come,
Now with much less worry.
But in my mind I wonder if,
This time, should I hurry?
I had to leave a (thankfully stable) patient mid-clerking because I got a "red call" on our Hospital At Night system for a patient a ward on the opposite side of the hospital with chest pain. The same patient who had previously been put on Hospital At Night as the wonderfully non-specific "general medical review. NEWS 4" with no extra information, which I'd immediately put further down my priority list than the four clerking I had to do. Ran all the way across the hospital, thinking the worst, that I'd delayed reviewing this patient and now she was deteriorating or having an MI. When I arrived she was sat up, chatting away with a cup of tea and a biscuit, and I was informed by the night staff that she was complaining of the same chronic back pain she always has, but because I hadn't come up yet they thought I might come quicker if they said chest pain. Really not sure how I kept my cool for that one.
Love the poem!
also, the Bleep and Run, the Bleep and Use the Phone, the Multiple Blank Bleeps, all fun ways to keep the mood light
In this modern age they should make a bleep with slightly advanced technology, something by which bleep screen could show 'what's the emergency'.