Emergency Pages Using a Computer-Based Anesthesiology Paging System in Ambulatory Surgical Centers: A Retrospective Review

Warner, Mary Ellen MD*; Chong, Elisa Y.; Lowe, Michael E. MD*; Sprung, Juraj MD, PhD*; Weingarten, Toby N. MD*

doi: 10.1213/ANE.0000000000000264
Economics, Education, and Policy: Research Report

BACKGROUND: The nature of pages associated with periprocedural emergency events in ambulatory centers has never being examined. Our institution has a proprietary anesthesiology paging system with hierarchical paging capabilities (emergency versus routine) and maintains a log of all events. Here, we describe emergency pages in our ambulatory surgery centers.

METHODS: We identified all emergency page activations between June 1, 2008, and December 31, 2012, in our ambulatory surgical centers. Electronic medical records were reviewed for rates and characteristics of pages such as primary cause, interventions performed, and outcomes.

RESULTS: During the study time frame, 120,618 procedures were performed and 93 emergency pages were recorded (7.7 per 10,000 cases, 95% confidence interval, 6.2–9.4), of which 51 originated in the procedure room and 42 outside the procedure room (16 before and 26 after the procedure). Among those, 14/93 were associated with serious events (1.2 per 10,000 cases). Among emergency pages for bradyarrhythmias (N = 35, 2.9 per 10,000 cases), 15 occurred during IV line placement in the preprocedural area, 11 during postprocedural recovery, and 9 during the procedure. Bradyarrhythmias accounted for 60.4% of pages outside the procedural room. In contrast, respiratory and airway events (N = 31, 2.6 per 10,000 cases) typically occurred in the procedural room (28 vs 9, P = 0.0006). Only 1 patient sustained permanent injury, myocardial infarction, and death 4 months later. Another patient died after 8 days from unrelated causes.

CONCLUSION: The rates of emergency page activations, especially those that are critical events, in our surgical ambulatory center are rare. Many emergency pages originated outside the procedural room; therefore, providers within these areas should be trained to promptly recognize and treat these events.

Published ahead of print May 22, 2014

From the *Department of Anesthesiology, and Mayo Medical School, Mayo Clinic, Rochester, Minnesota.

Accepted for publication February 3, 2014.

Published ahead of print May 22, 2014

Funding: From the Department of Anesthesiology, College of Medicine, Mayo Clinic, Rochester, MN, 55905. Research reported in this publication was also supported by the National Institute on Aging of the National Institutes of Health under Award Number R01AG034676. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

The authors declare no conflicts of interest.

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Address correspondence to Toby N. Weingarten, MD, Department of Anesthesiology, Mayo Clinic, 200 First St., SW, Rochester, MN 55905. Address e-mail to weingarten.toby@mayo.edu.

© 2014 International Anesthesia Research Society