Context Our general paediatric team has a diverse workforce delivering patient care. Bleeps are essential for communication.

Problem The current process has become inefficient for several reasons including large volume calls, bleeping incorrect persons and inappropriate bleeps. This has impacted significantly on doctors’ efficiency to respond to calls appropriately whilst continuing daily work routine.

Assessment of problem and analysis of its causes A recent Task mapping exercise revealed a disproportionately high representation of RMO2’s time spent answering pager bleeps, compared to other team members.

Intervention Sophisticated iBleep technology is currently used ‘out of hours’ to filter calls through a central co-ordinator, distributing tasks according to skill set and caseload, enabling RMO2 to focus upon unwell patients, improving patient safety. It also reduces interruptions which adversely affects performance, error rates and increases cognitive burden.

This project aimed to transfer the benefits of iBleep to daytime operational hours for a specific team.

Study design Following stakeholder meetings, iBleep access and training was arranged. Daily data collection sheets were completed by the RMO2s, to record the number, timing, reason and location of pager bleeps received.

Strategy for change iBleep pilot was implemented in November 2015.

Measurement of improvement Data collection restarted after 3 weeks to identify impact upon pager bleep volume. Electronically captured iBleep data was also analysed.

Effects of changes From 4–24^th November, 35 iBleeps were generated; 31% to RMO2, 3% to the site practitioner and 66% to the rest of the team.

Pre iBleep, the number of daily bleeps received by the RMO2 ranged from 1–31 (mean 11). However, following iBleep implementation these ranged 10–22 bleeps (mean 15). This coincides with significant increases in clinical workload, with a 30% increase in inpatient numbers.

Lessons learnt Implementation of the project has been challenging with respect to embedding a new system despite vigorous communication and education rollout. Initial resistance with staff engagement was encountered. Subsequent education has increased compliance.

Early analysis of the data shows RMO2 feedback has been positive. There is more equitable distribution of workload between RMO2 bleeps and the rest of the team. Team members have feelings of reduced bleep fatigue and more clinical time available.

Our data has shown similar number of conventional bleeps pre and post iBleep. A significant confounding factor is the seasonal increase in clinical workload and this has not translated into increased overall bleep numbers. This impact is likely derived from an improved bleep etiquette that has been part of the iBleep operating policy.

Message for others The pilot will continue, and future work will explore the psychological impact of the new system on RMO2 and further assessment of the effectiveness of this system.