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Multimodal observational assessment of quality and productivity benefits from the implementation of wireless technology for out of hours working
  1. John D Blakey1,
  2. Debbie Guy2,
  3. Carl Simpson2,
  4. Andrew Fearn2,
  5. Sharon Cannaby3,
  6. Petra Wilson4,
  7. Dominick Shaw1
  1. 1Respiratory Biomedical Research Unit, University of Nottingham, Nottingham, UK
  2. 2City Hospital Campus, Nottingham NHS University Hospitals NHS Trust, Nottingham, UK
  3. 3Health Sector Policy, Association of Chartered Certified Accountants, London, UK
  4. 4European Health and Care Team, Internet Business Solutions Group, Cisco Systems, Brussels, Belgium
  1. Correspondence to Dr Dominick Shaw;{at}


Objectives The authors investigated if a wireless system of call handling and task management for out of hours care could replace a standard pager-based system and improve markers of efficiency, patient safety and staff satisfaction.

Design Prospective assessment using both quantitative and qualitative methods, including interviews with staff, a standard satisfaction questionnaire, independent observation, data extraction from work logs and incident reporting systems and analysis of hospital committee reports.

Setting A large teaching hospital in the UK.

Participants Hospital at night co-ordinators, clinical support workers and junior doctors handling approximately 10 000 tasks requested out of hours per month.

Outcome measures Length of hospital stay, incidents reported, co-ordinator call logging activity, user satisfaction questionnaire, staff interviews.

Results Users were more satisfied with the new system (satisfaction score 62/90 vs 82/90, p=0.0080). With the new system over 70 h/week of co-ordinator time was released, and there were fewer untoward incidents related to handover and medical response (OR=0.30, p=0.02). Broad clinical measures (cardiac arrest calls for peri-arrest situations and length of hospital stay) improved significantly in the areas covered by the new system.

Conclusions The introduction of call handling software and mobile technology over a medical-grade wireless network improved staff satisfaction with the Hospital at Night system. Improvements in efficiency and information flow have been accompanied by a reduction in untoward incidents, length of stay and peri-arrest calls.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

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  • To cite: Blakey JD, Guy D, Simpson C, et al. Multimodal observational assessment of quality and productivity benefits from the implementation of wireless technology for out of hours working. BMJ Open 2012;2:e000701. doi:10.1136/bmjopen-2011-000701

  • Contributors DS, SC, PW, AF and JDB conceived of the ideas for study. DS, AF and JDB designed the study. DG, SC and PW undertook non-directive interviews and administered the questionnaires. CS collected and compiled data on cardiac arrest calls. AF and JDB acquired the clinical data. JDB, DES and DG reviewed the incident reports. JDB undertook the analyses. JDB and DES drafted the manuscript, which all authors critically reviewed and contributed to revising before submission.

  • Funding This project was funded by Nottingham University Hospitals NHS Trust, with salary contributions from the National Institute of Health Research (JDB), the University of Nottingham (DS), Cisco Systems (PW) and the Association of Certified Chartered Accountants (SC).

  • Competing interests PW is employed by the manufacturer of the medical-grade network used in this study (Cisco Systems). The other authors have no conflict of interest to declare. The commercial entities Cisco Systems and NerveCentre Software had no role in the design and execution of analyses and were not permitted access to analyse task or patient identifiable data.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Supplementary data are available as indicated in the body of the manuscript. Any task or event-level data contain information regarding the care of individual patients and as such detailed records remain confidential.