To page or not to page? A qualitative study of communication practices of general surgery residents and nurses



      Communication errors contribute to preventable adverse hospital events; however, communication between general surgery residents and nurses remains insufficiently studied. The purpose of our study was to use qualitative methods to characterize communication practices of surgical residents and nurses on inpatient general and intermediate care units to inform best practices and future interprofessional interventions.


      Our study cohort consisted of 14 general surgery residents and 13 inpatient nurses from a tertiary academic medical center. Focus groups were conducted via a secure video platform, recorded, and transcribed. Two authors performed open coding of transcripts for qualitative analysis. Codes were reviewed iteratively with themes generated via abductive analysis, contextualizing results within 3 domains of an established communication space framework: organizational, cognitive, and social complexity.


      Communication practices of general surgery residents and inpatient nurses are affected by workflow differences, disruptive communication patterns, and communication technology. Barriers to effective communication, as well as strategies used to mitigate challenges, were characterized, with select communication practices found to negatively affect the well-being of patients, nurses, and residents.


      Communication practices of general surgery residents and inpatient nurses are influenced by entrenched and interrelated organizational, technological, and interpersonal factors. Given that current communication practices negatively affect patient and provider well-being, collaboration between surgeons, nurses, systems engineers, health information technology experts, and other stakeholders is critical to (1) establish communication best practices, and (2) design interventions to assess and improve multiple areas (rather than isolated domains) of surgical interprofessional communication.

      Graphical abstract

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Sutcliffe K.M.
        • Lewton E.
        • Rosenthal M.M.
        Communication failures: an insidious contributor to medical mishaps.
        Acad Med. 2004; 79: 186-194
        • Hu Y.Y.
        • Arriaga A.F.
        • Roth E.M.
        • et al.
        Protecting patients from an unsafe system: the etiology and recovery of intraoperative deviations in care.
        Ann Surg. 2012; 256: 203-210
        • Manojlovich M.
        • Harrod M.
        • Holtz B.
        • Hofer T.
        • Kuhn L.
        • Krein S.L.
        The use of multiple qualitative methods to characterize communication events between physicians and nurses.
        Health Commun. 2015; 30: 61-69
        • Edwards A.
        • Fitzpatrick L.A.
        • Augustine S.
        • et al.
        Synchronous communication facilitates interruptive workflow for attending physicians and nurses in clinical settings.
        Int J Med Inf. 2009; 78: 629-637
        • Robinson F.P.
        • Gorman G.
        • Slimmer L.W.
        • Yudkowsky R.
        Perceptions of effective and ineffective nurse–physician communication in hospitals.
        Nurs Forum (Auckl). 2010; 45: 206-216
        • Greenberg C.C.
        • Regenbogen S.E.
        • Studdert D.M.
        • et al.
        Patterns of communication breakdowns resulting in injury to surgical patients.
        J Am Coll Surg. 2007; 204: 533-540
        • Dougherty M.B.
        • Larson E.
        A review of instruments measuring nurse-physician collaboration.
        J Nurs Adm. 2005; 35: 244-253
        • Hallet J.
        • Wallace D.
        • El-Sedfy A.
        • et al.
        Defining communication improvement needs in general surgery: an analysis of pages, communications, patterns, and content.
        J Surg Educ. 2016; 73: 959-967
        • Smith A.D.
        • de Vos M.S.
        • Smink D.S.
        • Nguyen L.L.
        • Ashley S.W.
        Text paging of surgery residents: efficacy, work intensity, and quality improvement.
        Surgery. 2016; 159: 930-937
        • Espino S.
        • Cox D.
        • Kaplan B.
        Alphanumeric paging: a potential source of problems in patient care and communication.
        J Surg Educ. 2011; 68: 447-451
        • Wiegmann D.A.
        • El Bardissi A.W.
        • Dearani J.A.
        • Daly R.C.
        • Sundt T.M.
        Disruptions in surgical flow and their relationship to surgical errors: an exploratory investigation.
        Surgery. 2007; 142: 658-665
        • Hill J.
        • Janko M.
        • Angell K.F.
        • et al.
        Hospital text paging communication as a surgical quality improvement initiative.
        J Surg Res. 2017; 213: 84-89
        • Heidemann L.
        • Petrilli C.
        • Gupta A.
        • et al.
        Improving interdisciplinary provider communication through a unified paging system.
        South Med J. 2016; 109: 378-382
        • Fang D.Z.
        • Patil T.
        • Belitskaya-Levy I.
        • Yeung M.
        • Posley K.
        • Allaudeen N.
        Use of a hands free, instantaneous, closed-loop communication device improves perception of communication and workflow integration in an academic teaching hospital: a pilot study.
        J Med Syst. 2017; 42: 4
        • Richardson J.E.
        • Ash J.S.
        The effects of hands free communication devices on clinical communication: balancing communication access needs with user control.
        AMIA Annu Symp Proc. 2008; 2008: 621-625
        • Wu R.C.
        • Morra D.
        • Quan S.
        • et al.
        The use of smartphones for clinical communication on internal medicine wards.
        J Hosp Med. 2010; 5: 553-559
        • Manocha S.
        • Speigelman J.
        • Miller E.
        • Solomon S.
        Smartphone technology: impact on interprofessional working relations between doctors and nurses.
        Healthc Q. 2020; 23: 34-42
        • Pirnejad H.
        • Niazkhani Z.
        • Berg M.
        • Bal R.
        Intra-organizational communication in healthcare--considerations for standardization and ICT application.
        Methods Inf Med. 2008; 47: 336-345
        • Manojlovich M.
        • Harrod M.
        • Hofer T.P.
        • Lafferty M.
        • McBratnie M.
        • Krein S.L.
        Using qualitative methods to explore communication practices in the context of patient care rounds on general care units.
        J Gen Intern Med. 2020; 35: 839-845
        • Manojlovich M.
        • Ameling J.M.
        • Forman J.
        • Judkins S.
        • Quinn M.
        • Meddings J.
        Contextual barriers to communication between physicians and nurses about appropriate catheter use.
        Am J Crit Care. 2019; 28: 290-298
        • Timmermans S.
        • Tavory I.
        Theory construction in qualitative research: from grounded theory to abductive analysis.
        Social Theory. 2012; 30: 167-186
        • Johnson C.M.
        • Khan A.
        • Stark S.
        • Samee M.
        A nurse shadowing program for physicians: bridging the gap in understanding nursing roles.
        JONA J Nurs Adm. 2020; 50: 310-313
        • Quan S.D.
        • Morra D.
        • Lau F.Y.
        • et al.
        Perceptions of urgency: defining the gap between what physicians and nurses perceive to be an urgent issue.
        Int J Med Inf. 2013; 82: 378-386
        • Carayon P.
        • Smith M.J.
        Work organization and ergonomics.
        Appl Ergon. 2000; 31: 649-662
        • Carayon P.
        • Gurses A.
        • Hundt A.S.
        • Ayoub P.
        • Alvarado C.J.
        Performance obstacles and facilitators of healthcare providers.
        Change Qual Hum Serv Work. 2005; 4: 257-276
        • Wu R.C.
        • Tran K.
        • Lo V.
        • et al.
        Effects of clinical communication interventions in hospitals: a systematic review of information and communication technology adoptions for improved communication between clinicians.
        Int J Med Inf. 2012; 81: 723-732
        • Carayon P.
        • Hundt A.S.
        • Karsh B.
        • et al.
        Work system design for patient safety: the SEIPS model.
        Qual Saf Health Care. 2006; 15: i50-i58
        • Plant M.A.
        • Fish J.S.
        Resident use of the Internet, e-mail, and personal electronics in the care of surgical patients.
        Teach Learn Med. 2015; 27: 215-223
        • Richardson J.E.
        • Shah-Hosseini S.
        • Fiadjoe J.E.
        • Ash J.S.
        • Rehman M.A.
        The effects of a hands-free communication device system in a surgical suite.
        J Am Med Inform Assoc. 2011; 18: 70-72
        • Fernando O.
        • Coburn N.G.
        • Nathens A.B.
        • Hallet J.
        • Ahmed N.
        • Conn L.G.
        Interprofessional communication between surgery trainees and nurses in the inpatient wards: why time and space matter.
        J Interprof Care. 2016; 30: 567-573
        • Foronda C.
        • MacWilliams B.
        • McArthur E.
        Interprofessional communication in healthcare: an integrative review.
        Nurse Educ Pract. 2016; 19: 36-40