How will UK hospitals let go of the pager?

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n February 2019, the UK’s NHS was told to stop using pagers by the end of 2021 in order to save money. At the time, the service still used approximately 130,000 pagers, roughly 10% of the total still in use globally. Not only was the technology considered to be archaic and outdated by many, but the devices were still costing the NHS about £6.6m per year.

While progress has since been made in phasing out the devices, with a number of hospitals and healthcare centres adopting alternative communications technologies, developments haven’t gone as fast as it was hoped two years ago. Considering the impact of the Covid-19 pandemic on healthcare services, it’s unsurprising that phasing out the pager hasn’t been prioritised when thousands of lives have been at stake.

But steps have still been taken in the right direction over the past year. NHSX, the government agency responsible for digitally transforming the UK health service, launched the Clinical Communications Procurement Framework in July. The service is designed to support NHS organisations in phasing out pagers, allowing them to either make a direct award to a new service provider or undertake a mini competition to select the provider best suited to their needs from an approved shortlist.

But the framework is running until August 2022, with the potential to extend for another 12 months, far later than the initial December 2021 goal. What technologies could begin to replace the pager over the coming years – and why do they need to go in the first place?

Only one national pager network still exists in the UK, Capita’s PageOne, after Vodafone axed its service in 2018. But the technology is far from obsolete just yet, and the way it works can actually make a lot of sense in a healthcare context.

Pagers are one-way communication devices that can receive short messages but can’t send any reply. To send a message, hospital staff can call an automated phone line or speak to a dedicated operator and leave a message. The recipient’s pager will then beep and either display a message or – if there’s too much information to send via the paging system – show a phone number to call. If they need to correspond back, the recipient must find another way to communicate, such as via a mobile phone message or a landline phone inside the hospital.

Refero medical director and clinical director Dr Ian Jackson says: “A doctor might be with a patient in the middle of a delicate procedure and unable to reply immediately, but they know they have been bleeped and that there is an issue.

“The downside is that when you have a moment to ring back, often the person who actually answers doesn’t have a clue why you were bleeped.”

While the inability to reply via pager can be a little arduous, pagers have several benefits over two-way communication systems. Mobile phones need regular recharging, for example, which isn’t a problem pagers face as their batteries can last for weeks.

Hospitals can also be dead zones for mobile phones and WiFi signals. Many walls inside hospitals are built extra thick to stop X-rays from penetrating through, but these can block mobile and internet signals as well. Pagers don’t have this problem, as they communicate through very high-frequency radio signals that aren’t blocked by thick walls. Mobile and WiFi networks are also known to interfere with hospital equipment, which doesn’t happen with pagers.

Pager signals are also more reliable than mobile signals, pinging off multiple satellites rather than just the nearest phone mast. This makes it almost guaranteed that messages will still come through, while web-based networks can experience slowdowns and unavailability that can lead to delayed messages or even stop them sending at all. If one paging satellite is down, others are usually working, but when a phone mast goes down there’s often no alternative until it’s fixed.

Critical communications specialist ETELM international sales director Paul Ward says: “Mobile operators may be proud of their nationwide coverage outside, but inside can be a different matter. Hospitals are typically sprawling buildings, often including a mix of building materials and robust walls to create restricted or extra-secure areas.

“In turn, this means that patchy coverage and dead zones are a reality in most healthcare settings, both in terms of mobile and WiFi networks. This means that relying solely on public networks to get healthcare practitioners to emergency scenarios within minutes could have major reliability issues.”

Despite the operational issues associated with replacing pagers with mobile devices, the new contenders arriving onto the healthcare communications market still maintain that the improved functionality of their systems make them ultimately superior to the pager.

Alertive is a mobile app that has already been rolled out by a number of NHS Trusts, many reaching out via the Clinical Communications Procurement Framework. It still centres the critical alerting aspects of a pager but facilitates two-way communication by allowing recipients can respond to the emergency alerts with their ability and intention to attend incidences.

It also features an intuitive clinical messaging platform where clinicians can discuss specific cases and is designed to be interoperable with most hospital systems. Plus, it is set up to failover to an SMS or email message if the in-app alert can’t go through.

“Although we’re there to replace the technology with a superior way of doing things, there isn’t a massive transformational change to the ways that people operate and work required on day one of implementing our system,” says Alertive CEO Matt Gauler. “Our solution will still simply act like a pager solution.”

Alcidion’s Smartpage system, which operates via 4G and WiFi networks, was also appointed to the Clinical Communications Procurement Framework earlier this year.

Smartpage is designed to replace existing paging systems with a secure communication tool that has the same intuitive interface as a smartphone. The messages sent via the platform are integrated alongside patient records, vital sign data and early warning scores to catch any deterioration in a patient’s condition early. It also contains read receipts and instant two-way replies, with the intention of improving clinical collaboration, and allows for the sharing of images.

Alcidion general manager Lynette Ousby says: “Senior clinicians have told us about the challenges of not having access to even the most basic information about why they are bleeped – sometimes requiring them to leave a patient’s bedside to respond and access that information.

To be effective in their roles, clinicians need to be able to discuss patient care easily with any colleague, so technology that offers multi-person patient-centric communication is the obvious way forward.

“Modern systems are now preferable to support secure messaging, manage tasks, share critical information and to help to provide systematic ways of managing regular activities such as handovers that are important to patient safety.”

It’s clear that the pager falls short of systems like these when it comes to facilitating clear clinical communication – but they’re still reliant on technology like smartphones, tablets and laptops, which aren’t as practical in-clinic.

Many of the shortcomings of NHS pagers could be surpassed if they were able to send two-way messages – and by using Terrestrial Trunked Radio (TETRA) this could very well be made possible.

“It is easy to assume that emergency scenarios demand the very latest, next-generation technology. But the reality can be a little more complex,” says Ward. “Traditional radio devices using communications networks such as TETRA can offer a more standalone approach to in-hospital communications, which does not risk disrupting other equipment. This, clearly, is particularly important during times of crisis.”

TETRA have been around since 1995 and are in use by a number of emergency response teams globally. Motorola’s TETRA two-way pagers, for example, provide the Bavarian Federal Agency for Technical Relief with a device that can allow them to read and respond to messages on a two-inch colour display. Rather than replacing all of the pagers in the NHS with smartphones, an improved two-way paging system could be the answer.

Of course, a TETRA pager is still a pager, and will lack the detailed conversational elements of platforms like Alertive and Alcidion. But the ability to send even limited replies back – indicating whether or not it’s possible to attend A&E, for example – could be a significant improvement to the day-to-day operations of hospital staff. Plus, the shortfalls associated with digital solutions, such as comparatively poor signal and battery performance, are bypassed entirely.

“TETRA can actually be more reliable and offer more comprehensive coverage than their newer counterparts,” says Ward. “Reliable communications between medical practitioners in hospitals and healthcare settings are clearly absolutely critical – a matter of life and death. Doctors may need to be summoned within seconds in order to respond to an emergency scenario. The unfolding coronavirus pandemic has brought this into sharper focus than ever before.”